A myofascial syndrome due to continuous muscle contraction with the trigger point at the upper lateral edge of the nuchal muscles where they attach to the occipital bone is frequently seen in daily pain clinic practice. The Tienchu syndrome is a myofascial condition of the posterior neck region with a trigger point at the Tienchu acupoint(B10). When advanced, occipital neuralgia and muscle contraction headache follow. Therefore, a Tienchu block and/or occipital nerve block with local anesthetic combined with a small dose of steroid is a most effective therapeutic method for many patients who complain of posterior headache or posterior neck pain.