Background Occipital nerve block (ONB) is an injection of local anaesthetic, often with corticosteroid, given around the greater occipital nerve in primary and secondary headache disorders. Growing local demand and sparse national guidance prompted this audit to aid service design.

Aim Establish local demand and efficacy of ONB. We will then consider changes to the service and re- audit.

Standards No national guidelines available; standards determined through literature review.

Methods Retrospective review of local ONBs for January–August 2014. Data reported by patients (n=17) through standardised questions, asking about each ONB administered (n=23).

Results Patients experienced a mean 23 days headache freedom, 42% reduction in headache severity, and 38% reduction in headache days per week. Mean duration of effect was 44 days. Analgesia use fell after 70%, but 9% increased. Mild complications included injection site pain (65%); no moderate or severe complications.

Discussion These data support the use of ONB to treat headache. Sample is insufficient to determine efficacy by headache type. The following targets are identified for improving the service; audit will be repeated following implementation:

1. Improve staffing and facilities for this increasingly popular service.

2. Formalise follow-up arrangements.

3. Consider routine scheduling of repeat procedures for appropriate patients.