Conflict of Interest: None.
Transient Facial Nerve Palsy After Occipital Nerve Block: A Case Report
Article first published online: 10 JUN 2014
© 2014 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 54, Issue 10, pages 1651–1655, November/December 2014
How to Cite
Strauss, L., Loder, E. and Rizzoli, P. (2014), Transient Facial Nerve Palsy After Occipital Nerve Block: A Case Report. Headache: The Journal of Head and Face Pain, 54: 1651–1655. doi: 10.1111/head.12403
- Issue published online: 14 NOV 2014
- Article first published online: 10 JUN 2014
- Manuscript Accepted: 1 MAY 2014
- facial nerve palsy;
- greater occipital nerve block;
- lesser occipital nerve block;
- scalp block
Occipital nerve blocks are commonly performed to treat a variety of headache syndromes and are generally believed to be safe and well tolerated. We report the case of an otherwise healthy 24-year-old woman with left side-locked occipital, parietal, and temporal pain who was diagnosed with probable occipital neuralgia. She developed complete left facial nerve palsy within minutes of blockade of the left greater and lesser occipital nerves with a solution of bupivicaine and triamcinolone. Magnetic resonance imaging of the brain with gadolinium contrast showed no abnormalities, and symptoms had completely resolved 4-5 hours later. Unintended spread of the anesthetic solution along tissue planes seems the most likely explanation for this adverse event. An aberrant course of the facial nerve or connections between the facial and occipital nerves also might have played a role, along with the patient's prone position and the use of a relatively large injection volume of a potent anesthetic. Clinicians should be aware that temporary facial nerve palsy is a possible complication of occipital nerve block.