Procedure Description
A third occipital nerve (TON) block is a minimally invasive injection used to diagnose and treat pain related to the C2-C3 facet joint and the third occipital nerve, which runs along the back of the neck and upper scalp. This nerve is commonly involved in cervicogenic headaches (headaches that originate from the neck) and upper cervical facet joint pain.
The procedure involves injecting a local anesthetic, with or without a corticosteroid, near the third occipital nerve to numb the nerve, reduce inflammation, and interrupt pain signals. It may be used diagnostically (to confirm the source of pain) or therapeutically (to relieve symptoms).
What It Treats
A third occipital nerve block is used to manage:
Cervicogenic headaches (headaches originating from the cervical spine)
Chronic upper neck pain
Pain following whiplash or neck trauma
Arthritis or degeneration at the C2-C3 facet joint
Post-laminectomy or post-surgical neck pain
Occipital neuralgia involving the upper cervical region
Symptoms that may benefit from this procedure include:
Headaches beginning in the neck or upper back of the head
Tenderness over the C2-C3 region
Pain worsened by neck movement or sustained posture
How It Is Performed
You will lie face down on a procedure table with your head comfortably supported.
The skin over the upper neck is cleansed and numbed with local anesthetic.
Using fluoroscopy (X-ray) or ultrasound guidance, a thin needle is inserted near the C2-C3 facet joint, where the third occipital nerve is located.
A small amount of contrast dye may be used to confirm accurate needle placement.
A mixture of local anesthetic and possibly corticosteroid is injected around the nerve.
The needle is removed, and a small bandage is applied.
The procedure typically takes 15–30 minutes and is performed in an outpatient setting.
Pre-Procedure Instructions
No fasting is needed unless sedation is planned (which is uncommon).
Take your regular medications unless advised otherwise. Blood thinners may need to be paused before the procedure—follow your provider’s instructions.
Inform your provider if you:
Are pregnant or breastfeeding
Have allergies to anesthetics, steroids, or contrast dye
Have a bleeding disorder or active infection
Wear loose, comfortable clothing, and avoid wearing jewelry around the neck.
What to Expect After the Procedure
You may experience immediate pain relief from the anesthetic, which typically lasts several hours.
If a steroid is used, longer-lasting relief may develop over a few days.
Mild soreness or stiffness at the injection site is normal and usually resolves within 1–2 days.
Avoid strenuous activity for 24 hours, but light activity is typically safe.
You may be asked to track your pain levels to assess how well the injection worked.
If the block provides temporary relief, and the pain returns, your provider may recommend:
Repeat injections
Radiofrequency ablation (RFA) of the third occipital nerve for longer-lasting relief
Call your provider if you experience:
Fever or signs of infection
New or worsening headache or neck pain
Numbness or weakness that lasts longer than expected
Precise Pain Relief for Head and Upper Neck Conditions
At Parkview Spine & Pain, we use third occipital nerve blocks to effectively diagnose and treat headaches and neck pain that originate from the upper cervical spine. Whether due to arthritis, trauma, or nerve irritation, this targeted approach can help reduce symptoms and restore function.
👉 Schedule your consultation today to find out if a third occipital nerve block is right for you.