Occipital and Sphenopalatine Nerve Blocks in Chicago
An occipital nerve block numbs the nerves at the back of the head that can drive migraine, occipital neuralgia and headaches that start in the neck. A third occipital nerve (TON) block targets the small nerve from the upper neck joint behind many neck-related headaches. A sphenopalatine ganglion (SPG) block numbs a nerve cluster behind the nose, and is used for cluster headache and migraine. Each is a short office procedure.
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Workers’ Comp, HMO referral or complex insurance? Call (312) 414-1088.
Where it’s done
All three blocks are done in the office, at our South Loop or Streeterville location. Every procedure is performed under fluoroscopy or ultrasound guidance.
Greater and lesser occipital nerve blocks
The greater occipital nerve, which allows for sensation in these regions, can become irritated or inflamed, leading to pain along the back or top of the head. Many patients describe this sensation as beginning at the base of the skull on one side and radiating to the eyes, forehead, and/or temple.
By performing steroid blocks in the occipital nerve, located in the back of the head, patients can find relief. This treatment is most successful in individuals with migraines, cluster headaches, spondylosis of the cervical facet joints, and occipital neuralgia. It can take several days for the treatment to take effect, but relief can last for months in some cases.
The medicine is placed beside the greater occipital nerve, and the lesser occipital nerve when it is involved, at the base of the skull. The scalp over the area may feel numb for several hours afterward.
Third occipital nerve (TON) block
The third occipital nerve carries pain from the joint between the second and third neck bones (the C2–C3 facet joint). When that joint is the source, pain usually starts in the upper neck and spreads to the back of the head. It is common after whiplash, and it often gets worse when you turn or tilt your head.
Why a TON block is done first
A TON block is first a test. A small amount of local anesthetic is placed on the nerve; if your headache eases while it is numb, that joint is confirmed as the source.
Many patients receive two blocks on separate days. The first uses a shorter-acting local anesthetic and the second a longer-acting one. Relief that matches each anesthetic’s duration confirms the diagnosis before ablation.
When both blocks help, radiofrequency ablation of the third occipital nerve can calm the pain for longer. When RFA is done properly, relief typically lasts 3–6 months, which is about how long it takes the nerve to regenerate.
Talk to Dr. Elbaridi about headache nerve blocks
Same-week appointments at our South Loop and Streeterville offices.
Opens our secure booking calendar — this page stays open.
Workers’ Comp, HMO referral or complex insurance? Call (312) 414-1088.
Sphenopalatine ganglion (SPG) block
The sphenopalatine ganglion is a small cluster of nerves deep behind the nose, connected to the nerves of the face. It is involved in cluster headache, in migraine with pain or pressure behind the eye, and in some kinds of facial pain.
No needle in the skin
You lie on your back while a thin, soft applicator is passed gently through each nostril, and local anesthetic is placed beside the ganglion. Its position is checked with fluoroscopy. You stay lying down for a few minutes while the medicine settles.
Some patients have a series of SPG blocks over several weeks. Dr. Elbaridi decides the schedule with you based on how you respond.
Who these blocks are for
Dr. Elbaridi decides which block, if any, fits your headache after your consultation, your exam and your imaging. You may be a candidate if you have:
- headaches that start in the neck or at the base of the skull
- neck-related headaches after a car accident or a work injury
- occipital neuralgia: sharp, shooting or electric pain at the back of the head
- cluster headaches
- migraines that haven’t improved enough with medications, physical therapy or other treatment
For chronic migraine, 15 or more headache days a month, Botox is another option.
Who is not a candidate
A nerve block may not be appropriate when:
- there is an active infection, especially near the injection site
- bleeding risk is not adequately controlled
- you are allergic to the medicines used
- a blockage or recent surgery inside the nose prevents an SPG block
- you decide not to go ahead with treatment
When a headache is an emergency
A sudden, severe headache, a headache with fever and a stiff neck, or a headache with new weakness, confusion, or changes in vision or speech needs emergency care, not a nerve block.
The day of your block
Anesthesia
The skin is numbed with local anesthetic. Sedation is not usually needed.
How long it takes
The block itself takes about 10 to 20 minutes, and you go home the same day. After a TON block, arrange for someone to drive you home.
Afterward
Most patients return to normal daily activity the next day. Keep a simple headache diary for the next few days, so Dr. Elbaridi can see how much the block helped.
Expected, temporary effects
- numbness of the scalp after an occipital block
- brief unsteadiness or lightheadedness after a TON block
- a bitter taste, numb throat or watery eyes after an SPG block
- soreness or a small bruise where the needle was placed
Blocks as part of recovery
A bridge to recovery, not a lifelong treatment
We believe movement is the essence of recovery: physical therapy, yoga and strengthening. Pain management is an important intermediate step. It brings pain down enough for you to do the work that keeps you better.
For headaches that start in the neck, that work is usually neck and upper-back strengthening and posture training.
An interdisciplinary plan
Dr. Elbaridi performs the full spectrum of interventional pain management, from diagnostic nerve blocks and radiofrequency ablation to minimally invasive spine procedures and implanted devices. Every plan is interdisciplinary: physical therapy, movement and strengthening, coordinated with your primary care doctor and, when needed, a spine surgeon.
When appropriate, treating the source of the pain is often a better strategy than relying on long-term opioids.
Dr. Nidal Elbaridi, MD
- Anesthesiologist and interventional pain physician
- Interventional pain fellowship, Harvard Medical School / Brigham and Women’s Hospital (2016)
- Anesthesiology residency, John H. Stroger Jr. Hospital of Cook County (2015)
- MD, Ross University School of Medicine (2010)
- Former licensed physical therapist (B.S., Indiana University, 1997)
Insurance and prior authorization
- We do not charge out-of-network rates. We verify benefits and pre-authorize before your procedure, so there are no surprise bills afterward.
Most insurance accepted, including Medicare, Medicare Advantage, PPO and HMO plans. Coverage depends on medical necessity — we verify before your visit.
Headaches after a work injury or accident
Your first visit can happen this week. Procedures are pre-authorized with the carrier before they’re scheduled.
We also accept Workers’ Compensation and Personal Injury (Letter of Protection) cases. See Workers’ Comp and personal injury, or call (312) 414-1088.
Occipital and SPG block questions, answered
What’s the difference between an occipital nerve block and a third occipital nerve block?
An occipital nerve block numbs the nerves that run up the back of the head. A third occipital nerve block numbs a smaller nerve from the upper neck joint, to find out whether that joint is causing your headache.
Does an SPG block involve a needle?
No. The medicine is placed through the nose with a thin, soft applicator. Most patients feel pressure and a brief sting, not pain.
How soon will I feel relief?
Numbness from the local anesthetic starts within minutes. When a steroid is included, it can take several days to take effect. How long relief lasts varies from person to person.
Can I drive home afterward?
Arrange for a ride after a TON block, since brief unsteadiness is common. After an occipital or SPG block, most patients can drive once they feel steady; ask us the day of your visit.
Can nerve blocks be combined with Botox for chronic migraine?
Yes. Some patients with chronic migraine, 15 or more headache days a month, have both. Dr. Elbaridi decides with you whether a combination fits your headache pattern.
Are these blocks covered by insurance?
Coverage depends on medical necessity, and we verify before your visit. We verify benefits and pre-authorize before your procedure, so there are no surprise bills afterward.
Book your appointment at Loop Medical Center
Same-week appointments at our South Loop and Streeterville locations.
Opens our secure booking calendar — this page stays open.
Workers’ Comp, HMO referral or complex insurance? Call (312) 414-1088.