Ultrasound-guided blocks of the greater, lesser, and third occipital nerves are safe and effective in several primary and secondary headaches and in neck pain. The small nerves in their surrounding tissues can reliably be visualized with today’s high-frequency transducers, including identification of anatomic variabilities. Local anesthetic injection around the nerves is imaged in real time, assuring maximum block specificity with a minimum of volume. This textbook chapter provides a comprehensive, up-to-date review of occipital nerve neuroanatomy, block indications, mechanisms of action, detailed block techniques and sonography, together with useful tips and tricks for successful interventional head and neck pain management.