Greater occipital nerve block

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The greater occipital nerve often accompanied by dizziness, migraine, heavy head, eyes looked like sleep, may have severe nausea, dizzy, afr


The greater occipital nerve often accompanied by dizziness, migraine, heavy head, eyes looked like sleep, may have severe nausea, dizzy, afraid to turn around. The occipital protuberance is located in the Chinese position slightly above the Fengchi point, with the hand can touch the head slightly uplift (shown black arrow pointing at), it is the attachment point of levator scapulae muscle muscle, small diamond, with several layers of fascia and tendon, prone to inflammation (attachment point, these muscles in the bottom of the scapula in the corner x place). When the muscle is attached to the site, there is a point of tenderness, causing pain and radiating to the middle of the neck, so the patient will have a feeling of neck hair.

At the bottom of the occipital protuberance, occipital nerve passes through the fascia (white arrow icon in the multi head forward), dominating the lateral half of the head; and then move forward for the supraorbital nerve innervation around the eyes feeling. Attached to the external occipital protuberance muscle inflammation, edema, easy entrapment of the nerve occurred, head heavy, eyes looked like sleep. Sometimes produces half of the head like lightning pain, often misdiagnosed as migraine, even playing ergotamine. Due to the great occipital nerve through, to go through a few layers of the fascia, the patient in turn, muscle contraction will increase the pressure and distortion of the nerve and dizziness, nausea symptoms, so patients do not dare to turn the head. The greater occipital nerve is located adjacent to the spinal nerve and the branches of the sympathetic nerve and vertebral artery are adjacent to each other. Occipital nerve stimulation usually reflex sympathetic nerve stimulation and vertebral artery, so the patient can produce dizziness, nausea, dizzy symptom.

Applied anatomy

According to the characteristics of the anatomy of the greater occipital nerve, the greater occipital nerve can be divided into the intramuscular segment and the inner segment of the fascia. Greater occipital nerve. It is the only branch of spinal nerve, which is the only branch of spinal nerve, which is the most extensive branch of posterior ramus. The greater occipital nerve) C2 after the inside of the nerve branch, a canal curved around the head under the oblique lower edge to walk, and the sagittal plane was about 70 degrees, 60 degrees between the coronary plane, through the semispinalis muscle and longest muscle of head. The starting point of the greater occipital nerve is located on the spinous process of 2.0cm C2, followed by 2.5cm. In the spinous process of C2 about 2.2cm above, after on the midline by about 2.5cm in and out of muscle, trapezius muscle and sternocleidomastoid muscle fiber stop point close to a deep layer of fascia, fascia in a horizontal position, oblique to the outside, to segment and posterior midline was about 30 degrees to 40 degrees. On line adjacent to 55 degrees to 70 degrees, the walking distance of about 5cm, in a line from the external occipital protuberance at about 3.5cm, the shallow subcutaneous trapezius of a fiber cable pore formation between the belt and the occipital bone, a diameter of about 2mm. A shallow subcutaneous, and occipital artery accompanying, divided into 2 ~ 5, dominant occipital skin, cutaneous branch far to coronary anatomy.

Greater occipital nerve block (larger occipital nerve block)

Operation method

(1) a sitting or prone position, head slightly flexion and neutral position. Weak patients for prevention of cerebral ischemia can take prone position.

(2) at the midpoint of the external occipital protuberance of the puncture point, the upper side of the mastoid side of the affected side was opened on the 62.5px line. On line for the external occipital protuberance extends to both sides of the arched curved lines, for the trapezius tdc.

(3) the conventional method of disinfection of skin puncture point, first touch in marking the puncture point in the occipital artery, pulsatility significantly at the medial vertical slowly into the needle, the emergence of radiation pain after withdrawing without blood injection of 1% lidocaine or 0.25% bupivacaine solution 2~3ml.


(1) occipital neuralgia pain after occipital head, neck, jaw and began to radiate to the ear, like facial pain, touch the scalp and hair surface can induce pain.

(2) cervical headache

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