Clin Pain.  2019 Jun;18(1):24-30. 10.0000/cp.2019.18.1.24.

Ultrasound-Guided Greater Occipital Nerve Block for Primary Headache: Comparison of Two Techniques by Anatomical Injection Site

  • 1Department of Physical Medicine & Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
  • 2Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University, Seoul, Korea.
  • 3Department of Physical Medicine & Rehabilitation, Kyung Hee Medical Center, Seoul, Korea.


Greater occipital nerve block (GONB) is a widely accepted treatment of primary headaches. Two ultrasound (US)-guided blockade techniques exist: 1) the classical distal nerve block technique performed medial to the occipital artery at the superior nuchal line, and 2) the new proximal nerve block technique performed at the obliquus capitis inferior muscle at the level of C2. Our study aim was to perform a head-to-head comparative study of these two US-guided techniques. METHOD: Forty-nine patients with primary headache treated in our university hospital were recruited. Patients were randomized into two groups of the classical nerve block and the new proximal nerve block techniques. The headache questionnaire was made to assess the intensity of the pain of headache attacks, number of days they experience headache, duration of headache, and amount of pain medication they consumed.
In both groups, a decrease in the severity and frequency of the headache was observed. There was no measurable difference in outcome between the two groups.
Our study showed that the classic and new proximal techniques are equally effective in decreasing the headache severity and frequency.


Greater occipital nerve; Primary headache; Ultrasound-guided blockade
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