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CHAPTER 227 – Greater and Lesser Occipital Nerve Block

The greater occipital nerve arises from fibers of the dorsal primary ramus of the second cervical nerve and to a lesser extent from fibers of the third cervical nerve. The greater occipital nerve pierces the fascia just below the superior nuchal ridge along with the occipital artery. It supplies the medial portion of the posterior scalp as far anterior as the vertex.

The lesser occipital nerve arises from the ventral primary rami of the second and third cervical nerves. The lesser occipital nerve passes superiorly along the posterior border of the sternocleidomastoid muscle, dividing into cutaneous branches that innervate the lateral portion of the posterior scalp and the cranial surface of the pinna of the ear.


The patient is placed in a sitting position with the cervical spine flexed and the forehead on a padded bedside table. A total of 8 mL of local anesthetic is drawn up in a 12-mL sterile syringe. When treating occipital …