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Occipital neuralgia is a chronic headache condition described as paroxysmal, severe, sharp, and shooting type in the dermatome of greater and lesser occipital nerve. The exact cause is not known but could be associated with trauma, entrapment, or inflammation of the occipital nerve. Headache may have been one of the symptoms in multiple sclerosis including the neuralgic form of headache but there is no definite study to say the exact incidence and prevalence of occipital neuralgia in multiple sclerosis. It is very difficult to diagnose occipital neuralgia from various differentials of chronic headaches and the management of the disease is also a complex thing. We report a case of multiple sclerosis with chronic headache with features suggestive of occipital neuralgia. Ultrasound-guided diagnostic right-sided occipital nerve block was done with immediate pain relief followed by ultrasound-guided cryoneurolysis of all three occipital nerves bilaterally. The patient reported significant pain relief. Increasing the use of ultrasonography in pain medicine, ultrasound-guided occipital nerve block could be one of the promising methods for diagnosing and treating occipital headaches. With the use of ultrasonography exact location of the nerves, real-time image of the needle and its advancement could be visualized. This provides the advantage of accurate needle entry into the target tissue with less injury to surrounding tissue. [ABSTRACT FROM AUTHOR]