This document addresses occipital nerve blocks (or blockade) and sphenopalatine ganglion nerve blocks as a therapy for treatment of headache syndromes. Occipital nerve block therapy involves injection of a local anesthetic with or without steroid around the greater and lesser occipital nerves located in the back of the head just above the neck area. These occipital nerve block procedures have been studied for the treatment of various headache syndromes and occipital neuralgia. Sphenopalatine ganglion nerve blocks involve intranasal insertion of topical anesthetic to block the sphenopalatine ganglion.

Note: Occipital nerve blockade as a diagnostic method for the evaluation of headaches and occipital neuralgia is not included within the scope of this document.

Position Statement

Investigational and Not Medically Necessary:

Occipital nerve block therapy is considered investigational and not medically necessary for the treatment of occipital neuralgia and headache syndromes including, but not limited to, chronic migraine, chronic daily headache, cervicogenic and cluster headache.

Sphenopalatine ganglion nerve block therapy is considered investigational and not medically necessary for all indications including, but not limited to, the treatment of migraine headaches and non -migraine headaches.