Answer: B. Lidocaine. Lidocaine can be used subcutaneously to block the occipital nerve. Generally, 1-2% lidocaine is drawn up into a 3-mL syringe, which is topped off with a 27 or 30 gauge needle (note: a 50/50 mix of lidocaine and 0.5% bupivacaine may also be used).
Then get behind the patient and locate a point one third of the way from the inion to the mastoid (along the nuchal line) and slowly infiltrate the subcutaneous space, fanning the needle, 1.5 cc per side. The patient may feel numb in the injected area for a few hours, but there are no other side effects.
This quiz is based on an earlier article written by Dr McAllister that you can read here: Take a Shot at Headache: 5 Useful In-office Injectables
For additional reading on headache and migraine, return to the Patient Care Online Headache and Migraine topic resource center.