Abstract
The greater occipital nerve (GON) is the main sensory nerve to the occipital area and has been associated with various pain syndromes such as occipital neuralgia, cervicogenic headaches, and migraines. GON derives most of its fibers from the C2 dorsal root, and blocks of this peripheral nerve can provide substantial pain relief.
Introduction
The greater occipital nerve (GON) is the main sensory nerve to the occipital area and has been associated with various pain syndromes such as occipital neuralgia, cervicogenic headaches, and migraines. GON derives most of its fibers from the C2 dorsal root, and blocks of this peripheral nerve can provide substantial pain relief.
This chapter describes an in-plane ultrasound-guided technique.
In-Plane Technique
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Patient in a prone, side-lying, or seated position with the head slightly flexed.
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Move ultrasound transducer ipsilaterally over GON. Interventionist is contralateral and in line with the transducer and ultrasound screen on the opposite side (see Figure 33.1A ).
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Using a high-frequency linear array transducer, localize the bifid spinous process of C2. C1 does not have a bifid spinous process.
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Slide laterally toward the ipsilateral C2 lamina.
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Rotate the lateral part of the transducer cephalad until the transverse process of C1 is visualized (around 20–30 degrees). At this point, you should be able to visualize the relevant muscular tissue planes and GON ( Figs. 33.1B and C ).
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