Greater and Lesser Occipital Nerve Blocks for Frequent and Severe Headaches in Children and Adolescents: A Protocolized Repetitive Intervention Study

Headache management in children and adolescents remains challenging, particularly in patients with high headache-related disability, medication overuse, and comorbid conditions, for whom evidence-based preventive treatment options are limited and often ineffective. This study aimed to evaluate the clinical outcomes and safety of a protocolized, repetitive bilateral greater and lesser occipital nerve block (GONB/LONB) strategy in pediatric patients with frequent and severe headaches. This retrospective study included adolescents aged 11–18 years who underwent bilateral GONB and LONB for headache between 2018 and 2025. At each treatment session, 1 mL of 2% lidocaine was administered at each of four injection sites (bilateral GON and LON), corresponding to a total volume of 4 mL (80 mg) per session. Blocks were administered weekly for 4 weeks, followed by additional applications at 1 and 3 months. Headache severity and disability were evaluated using the visual analog scale (VAS) and the Pediatric Migraine Disability Assessment (PedMIDAS) before and after completion of the block protocol. Forty-five patients (91.1% female) received a total of 258 bilateral GONB/LONB procedures. The mean number of headache days per month was 20.8 ± 7.9, and the mean headache duration was 11.6 ± 10.7 months. Significant reductions were observed in both VAS and PedMIDAS disability grades following treatment ( p < 0.001). At the patient level, 41 of 45 patients (91.1%) met the predefined criteria for clinical response. No serious adverse events occurred. Protocolized repetitive bilateral GONB/LONB was well tolerated and was associated with reductions in headache severity and headache-related disability in this predominantly adolescent cohort. However, the uncontrolled retrospective design precludes attribution of these improvements specifically to the intervention. Prospective sham-controlled studies are needed to establish treatment-specific efficacy.