Supine Positioning After Greater Occipital Nerve Block May Improve Outcomes

woman laying on a couch with her hand on her head
woman laying on a couch with her hand on her head
After greater occipital nerve block, most patients reported freedom from pain with supine positioning.

Placing a patient in supine position after a greater occipital nerve (GON) block procedure may improve treatment outcomes, according to a study recently published in Clinical Neurology and Neurosurgery. It is known that a patient’s positioning affects local anesthetics; however, the effect of patient positioning on the clinical effectiveness of GON block treatment had never been analyzed previously. 

Researchers at the Cumbria Partnership NHS Foundation Trust conducted a prospective, single-center, non-randomized, proof-of-concept study including 95 consecutive patients who underwent a GON block procedure for treatment-refractory headache disorder to determine the clinical effectiveness of either sitting or lying supine post-GON block procedure. Immediately post-GON block procedure, participants chose to sit up (n=34) or lie down (n=61) for 10 minutes. 

In the supine group, 27 patients (44%) stated they experienced substantial benefit and 17 (28%) stated they experienced complete benefit (pain freedom) for a median length of 70 days and 84 days, respectively. In the sitting group, 10 patients (29%) stated they experienced substantial benefit and 6 (18%) stated they experienced complete benefit (pain freedom) for a median duration of 25 days and 119 days, respectively.

Researchers found through the Mann-Whitney U-test that a supine position imparts a longer post-GON block treatment headache-free period (P =.007) and median relief score (P =.017) than sitting. Additionally, backward multiple linear regression analyses demonstrated that the chronicity of a participant’s condition was negatively related to (beta =-.24, P =.024) headache-free period (days) and post-GON block treatment patient position was positively related to (beta =.25, P =.018) the attained headache-free duration. 

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Although the study was not randomized, participants in the 2 cohorts did not differ significantly in any patient demographics nor clinical parameters aside from baseline headache characteristics. Still, further research, in the form of a prospective multi-center, randomized, controlled trial, is necessary to confirm the observed benefit of supine patient positioning post-GON block procedure. 


Vanderpol J, Jonker L. Influence of patient positioning on reported clinical outcomes after greater occipital nerve block for treatment of headache: Results from prospective single-centre, non-randomised, proof-of-concept studyClin Neurol Neurosurg. 2019;176:73-77.