The efficacy of nerve block on headache intensity, frequency, and duration in patients with headache: a systematic review and meta-analysis

Background: Nerve block holds significant predictive and guiding value for subsequent minimally invasive procedures. This systematic review aimed to determine the effects of nerve block on cervicogenic headache. Methods: We searched the Cochrane Library, PubMed, EMBASE and Web of Science for randomized controlled trials (RCTs) involving adults (≥18 years) with cervicogenic headache who underwent nerve block. The major outcomes were pain intensity scores, weekly headache frequency, and headache duration before and after nerve block. We also assessed the outcomes according to different target nerves, corticosteroid combinations, and guiding methods. Results: A total of 17 studies (n = 885) were included in the review, all of which underwent qualitative synthesis, with 11 studies further subjected to quantitative synthesis. The results demonstrated that nerve block significantly alleviated pain, with a mean reduction of 1.62 points, and the effect was notable at 2 weeks, whereby pain intensity was reduced by 1.99 points. Nerve block also reduced headache frequency by 0.66 episodes/week and duration by 4.82 days. The efficacy did not significantly differ according to the target nerve, corticosteroid combination, or guiding method. Conclusion: Nerve block could relieve pain intensity and reduce the frequency and duration of cervicogenic headache, with the effect being significant at 2 weeks. Different target nerves, corticosteroid combinations, and guidance methods had no significant impact on efficacy. The PROSPERO Registration: CRD420251144807.

Cervicogenic headache; Pain; Nerve block; Greater occipital; Headache

[1] Martelletti P, van Suijlekom H. Cervicogenic headache: practical approaches to therapy. CNS Drugs. 2004; 18: 793–805.

[2] Piovesan EJ, Utiumi MAT, Grossi DB. Cervicogenic headache—how to recognize and treat. Best Practice & Research Clinical Rheumatology. 2024; 38: 101931.

[3] Nowaczewska M, Kierońska-Siwak S, Straburzyński M, Waliszewska-Prosół M, Gryglas-Dworak A. Clinical, demographic, and lifestyle characteristics of patients with cervicogenic headache: comparison with an age- and sex-matched group of individuals with migraine. The Journal of Headache and Pain. 2026; 27: 161.

[4] Sjaastad O, Bakketeig LS. Prevalence of cervicogenic headache: Vågå study of headache epidemiology. Acta Neurologica Scandinavica. 2008; 117: 173–180.

[5] Narouze S. C2 dorsal root ganglion: the central hub for cervicogenic headache. Current Opinion in Anaesthesiology. 2025; 38: 689–693.

[6] Becker WJ. Cervicogenic headache: evidence that the neck is a pain generator. Headache. 2010; 50: 699–705.

[7] Olesen J, Goadsby P, Steiner T. The international classification of headache disorders: 2nd edition. The Lancet Neurology. 2003; 2: 720.

[8] Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018; 38: 1–211.

[9] Dach F, Éckeli ÁL, Ferreira Kdos S, Speciali JG. Nerve block for the treatment of headaches and cranial neuralgias—a practical approach. Headache. 2015; 55: 59–71.

[10] Kondratiev A, Tomaselli GF. Altered gating and local anesthetic block mediated by residues in the I-S6 and II-S6 transmembrane segments of voltage-dependent Na⁺ channels. Molecular Pharmacology. 2003; 64: 741–752.

[11] Lerch JK, Puga DA, Bloom O, Popovich PG. Glucocorticoids and macrophage migration inhibitory factor (MIF) are neuroendocrine modulators of inflammation and neuropathic pain after spinal cord injury. Seminars in Immunology. 2014; 26: 409–414.

[12] Li JY, Xie W, Strong JA, Guo QL, Zhang JM. Mechanical hypersensitivity, sympathetic sprouting, and glial activation are attenuated by local injection of corticosteroid near the lumbar ganglion in a rat model of neuropathic pain. Regional Anesthesia and Pain Medicine. 2011; 36: 56–62.

[13] Wahezi SE, Silva K, Shaparin N, Lederman A, Emam M, Haramati N, et al. Currently recommended TON injectate volumes concomitantly block the GON: clinical implications for managing cervicogenic headache. Pain Physician. 2016; 19: E1079–E1086.

[14] Chowdhury D, Datta D, Mundra A. Role of greater occipital nerve block in headache disorders: a narrative review. Neurology India. 2021; 69: S228–S256.

[15] Caponnetto V, Ornello R, Frattale I, Di Felice C, Pistoia F, Lancia L, et al. Efficacy and safety of greater occipital nerve block for the treatment of cervicogenic headache: a systematic review. Expert Review of Neurotherapeutics. 2021; 21: 591–597.

[16] Evans AG, Joseph KS, Samouil MM, Hill DS, Ibrahim MM, Assi PE, et al. Nerve blocks for occipital headaches: a systematic review and meta-analysis. Journal of Anaesthesiology, Clinical Pharmacology. 2023; 39: 170–180.

[17] Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Medicine. 2009; 6: e1000097.

[18] Rothbart P, Fiedler K, Gale GD, Nussbaum D, Hendler N. A descriptive study of 100 patients undergoing palliative nerve blocks for chronic intractable headache and neck ache. Pain Research and Management. 2000; 5: 243–248.

[19] Ma D, Maimaitimin A, Wang Y. A novel ultrasound-guided “three in one” approach plus interfascial plane blocks for the treatment of cervicogenic headache. Local and Regional Anesthesia. 2024; 17: 1–8.

[20] Finlayson RJ, Etheridge JP, Vieira L, Gupta G, Tran DQ. A randomized comparison between ultrasound- and fluoroscopy-guided third occipital nerve block. Regional Anesthesia and Pain Medicine. 2013; 38: 212–217.

[21] Gale G, Nussbaum D, Rothbart P, Hann B, Leung V, Kanetz G. A randomized treatment study to compare the efficacy of repeated nerve blocks with cognitive therapy for control of chronic head and neck pain. Pain Research and Management. 2002; 7: 185–189.

[22] Pingree MJ, Sole JS, Oʼ Brien TG, Eldrige JS, Moeschler SM. Clinical efficacy of an ultrasound-guided greater occipital nerve block at the level of C2. Regional Anesthesia and Pain Medicine. 2017; 42: 99–104.

[23] Goldberg ME, Schwartzman RJ, Domsky R, Sabia M, Torjman MC. Deep cervical plexus block for the treatment of cervicogenic headache. Pain Physician. 2008; 11: 849–854.

[24] Lauretti GR, Corrêa SW, Mattos AL. Efficacy of the greater occipital nerve block for cervicogenic headache: comparing classical and subcompartmental techniques. Pain Practice. 2015; 15: 654–661.

[25] Vincent MB, Luna RA, Scandiuzzi D, Novis SA. Greater occipital nerve blockade in cervicogenic headache. Arquivos de Neuro-Psiquiatria. 1998; 56: 720–725.

[26] Naja ZM, El-Rajab M, Al-Tannir MA, Ziade FM, Tawfik OM. Occipital nerve blockade for cervicogenic headache: a double-blind randomized controlled clinical trial. Pain Practice. 2006; 6: 89–95.

[27] Naja ZM, El-Rajab M, Al-Tannir MA, Ziade FM, Tawfik OM. Repetitive occipital nerve blockade for cervicogenic headache: expanded case report of 47 adults. Pain Practice. 2006; 6: 278–284.

[28] Weibelt S, Andress-Rothrock D, King W, Rothrock J. Suboccipital nerve blocks for suppression of chronic migraine: safety, efficacy, and predictors of outcome. Headache. 2010; 50: 1041–1044.

[29] Gul HL, Ozon AO, Karadas O, Koc G, Inan LE. The efficacy of greater occipital nerve blockade in chronic migraine: a placebo-controlled study. Acta Neurologica Scandinavica. 2017; 136: 138–144.

[30] Mohamed ZE, Zarad CA, Flifel ME, Abou Elmaaty AA. The efficacy of ultrasound-guided multifidus cervicis plane block versus greater occipital nerve block for cervicogenic headache. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2021; 57: 11.

[31] Zagorulko O, Medvedeva L, Drakina O, Shevtsova G, Andropova A. The treatment of cervicogenic headache with occipital central cold segmental blockade. Journal of the Neurological Sciences. 2023; 455: 121618.

[32] Na SH, Kim TW, Oh SY, Kweon TD, Yoon KB, Yoon DM. Ultrasonic doppler flowmeter-guided occipital nerve block. Korean Journal of Anesthesiology. 2010; 59: 394–397.

[33] Ryu JH, Shim JH, Yeom JH, Shin WJ, Cho SY, Jeon WJ. Ultrasound-guided greater occipital nerve block with botulinum toxin for patients with chronic headache in the occipital area: a randomized controlled trial. Korean Journal of Anesthesiology. 2019; 72: 479–485.

[34] Wan Q, Yang H, Li X, Lin C, Ke S, Wu S, et al. Ultrasound-guided versus fluoroscopy-guided deep cervical plexus block for the treatment of cervicogenic headache. BioMed Research International. 2017; 2017: 4654803.

[35] Kovacs FM, Abraira V, Royuela A, Corcoll J, Alegre L, Tomás M, et al.; Spanish Back Pain Research Network. Minimum detectable and minimal clinically important changes for pain in patients with nonspecific neck pain. BMC Musculoskeletal Disorders. 2008; 9: 43.

[36] Bogduk N. Cervicogenic headache: anatomic basis and pathophysiologic mechanisms. Current Pain and Headache Reports. 2001; 5: 382–386.

[37] Hoffmann J, Mehnert J, Koo EM, May A. Greater occipital nerve block modulates nociceptive signals within the trigeminocervical complex. Journal of Neurology, Neurosurgery, and Psychiatry. 2021; 92: 1335–1340.

[38] Yuba T, Koyama Y, Kinishi Y, Fujino Y, Shimada S. The short term impact of radiofrequency ablative techniques and peripheral nerve block on thermoregulation in mouse models. Scientific Reports. 2024; 14: 30956.

[39] Bogduk N, Govind J. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. The Lancet Neurology. 2009; 8: 959–968.

[40] Grgić V. Cervicogenic headache: etiopathogenesis, characteristics, diagnosis, differential diagnosis and therapy. Lijec̆nic̆ki Vjesnik. 2007; 129: 230–236. (In Croatian)

[41] Vincent MB. Cervicogenic headache: the neck is a generator: con. Headache. 2010; 50: 706–709.

[42] Ludwig HC, Kolle M, Jansen J. Glycerol gangliotomy of the second dorsal cervical root in rats: an experimental study to evaluate a minimal invasive approach for the treatment of the chronic cervicogenic headache. Cephalalgia. 1998; 18: 612–617.

[43] Go D, Gould M, Ganti L. History of the nerve block. Orthopedic Reviews. 2024; 16: 125260.

[44] Kashipazha D, Nakhostin-Mortazavi A, Mohammadianinejad SE, Bahadoram M, Zandifar S, Tarahomi S. Preventive effect of greater occipital nerve block on severity and frequency of migraine headache. Global Journal of Health Science. 2014; 6: 209–213.

[45] Tang Y, Kang J, Zhang Y, Zhang X. Influence of greater occipital nerve block on pain severity in migraine patients: a systematic review and meta-analysis. The American Journal of Emergency Medicine. 2017; 35: 1750–1754.

[46] Ünal-Artık HA, İnan LE, Ataç-Uçar C, Yoldaş TK. Do bilateral and unilateral greater occipital nerve block effectiveness differ in chronic migraine patients? Neurological Sciences. 2017; 38: 949–954.

[47] Ward JB. Greater occipital nerve block. Seminars in Neurology. 2003; 23: 59–62.

[48] Taha NA, Fathy M, Elsadek A, Emara TH, Farag SM, Moustafa RR, et al. Efficacy and safety of ultrasound-guided peripheral nerve blocks in management of chronic resistant migraine. The Journal of Headache and Pain. 2025; 26: 80.

[49] Luo J, Duan G, Huang H, Chen G. Research status of different adjuvants on nerve block’s effect. Pain Physician. 2024; 27: 507–519.

[50] Velásquez-Rimachi V, Chachaima-Mar J, Cárdenas-Baltazar EC, Loayza-Vidalon A, Morán-Mariños C, Pacheco-Barrios K, et al. Greater occipital nerve block for chronic migraine patients: a meta-analysis. Acta Neurologica Scandinavica. 2022; 146: 101–114.

[51] Zagorulko OI, Medvedeva LA. The efficacy of therapeutic nerve blocks in patients with cervicogenic headache. S.S. Korsakov Journal of Neurology and Psychiatry. 2019; 119: 37–40. (In Russian)

[52] Zhang Y, Qin Z, Dong J, Zhang C, Feng J, Wang W, et al. Comparative efficacy of fascia iliaca compartment block using liposomal bupivacaine versus ropivacaine for preoperative analgesia in elderly patients with intertrochanteric femur fracture: a randomised controlled trial protocol. BMJ Open. 2025; 15: e093756.

[53] Wu L, Wei SW, Chen Z, Jiang LD, Qu SQ, Du Z. Ultrasound-guided paravertebral block with liposomal bupivacaine vs. non-liposomal bupivacaine for postoperative pain control after the Nuss procedure in children: a randomized clinical trial. Journal of Clinical Anesthesia. 2025; 106: 111953.

[54] Merz-Herrala J, Leu N, Anderson E, Lambeck A, Jefferson J, Sobrero M, et al. Safety and pain reduction in emergency practitioner ultrasound-guided nerve blocks: a one-year retrospective study. Annals of Emergency Medicine. 2024; 83: 14–21.

[55] Bellingham GA, Bhatia A, Chan CW, Peng PW. Randomized controlled trial comparing pudendal nerve block under ultrasound and fluoroscopic guidance. Regional Anesthesia and Pain Medicine. 2012; 37: 262–266.

[56] Eun SS, Chang WS, Bae SJ, Lee SH, Lee DY. Computed tomography fluoroscopy-guided selective nerve root block for acute cervical disc herniation. Journal of Korean Neurosurgical Society. 2010; 48: 419–422.