diff --git a/src/api/routes/inscriptions.ts b/src/api/routes/inscriptions.ts
index 0be0e200..23c2017b 100644
--- a/src/api/routes/inscriptions.ts
+++ b/src/api/routes/inscriptions.ts
@@ -22,7 +22,7 @@ import {
   Order,
   InscriptionIdParam,
 } from '../types';
-import { handleInscriptionCache } from '../util/cache';
+import { handleChainTipCache, handleInscriptionCache } from '../util/cache';
 import {
   DEFAULT_API_LIMIT,
   hexToBuffer,
@@ -38,6 +38,7 @@ const IndexRoutes: FastifyPluginCallback<Record<never, never>, Server, TypeBoxTy
   options,
   done
 ) => {
+  fastify.addHook('preHandler', handleChainTipCache);
   fastify.get(
     '/inscriptions',
     {
diff --git a/src/api/util/cache.ts b/src/api/util/cache.ts
index 86e86ea2..aaaee1e9 100644
--- a/src/api/util/cache.ts
+++ b/src/api/util/cache.ts
@@ -19,6 +19,10 @@ export async function handleInscriptionCache(request: FastifyRequest, reply: Fas
   return handleCache(ETagType.inscription, request, reply);
 }
 
+export async function handleChainTipCache(request: FastifyRequest, reply: FastifyReply) {
+  return handleCache(ETagType.chainTip, request, reply);
+}
+
 async function handleCache(type: ETagType, request: FastifyRequest, reply: FastifyReply) {
   const ifNoneMatch = parseIfNoneMatchHeader(request.headers['if-none-match']);
   let etag: string | undefined;
@@ -26,6 +30,9 @@ async function handleCache(type: ETagType, request: FastifyRequest, reply: Fasti
     case ETagType.inscription:
       etag = await getInscriptionLocationEtag(request);
       break;
+    case ETagType.chainTip:
+      etag = await getChainTipEtag(request);
+      break;
   }
   if (etag) {
     if (ifNoneMatch && ifNoneMatch.includes(etag)) {
@@ -44,6 +51,7 @@ export function setReplyNonCacheable(reply: FastifyReply) {
 /**
  * Retrieve the inscriptions's location timestamp as a UNIX epoch so we can use it as the response
  * ETag.
+ * @param request - Fastify request
  * @returns Etag string
  */
 async function getInscriptionLocationEtag(request: FastifyRequest): Promise<string | undefined> {
@@ -62,7 +70,23 @@ async function getInscriptionLocationEtag(request: FastifyRequest): Promise<stri
     if (!inscription_id) return;
     return await request.server.db.getInscriptionETag({ inscription_id });
   } catch (error) {
-    return undefined;
+    return;
+  }
+}
+
+/**
+ * Get an ETag based on the last observed chain tip.
+ * @param request - Fastify request
+ * @returns ETag string
+ */
+async function getChainTipEtag(request: FastifyRequest): Promise<string | undefined> {
+  try {
+    const blockHeight = await request.server.db.getChainTipBlockHeight();
+    if (blockHeight) {
+      return blockHeight.toString();
+    }
+  } catch (error) {
+    return;
   }
 }
 
diff --git a/tests/cache.test.ts b/tests/cache.test.ts
index cb3fe606..9ecdcd3d 100644
--- a/tests/cache.test.ts
+++ b/tests/cache.test.ts
@@ -71,4 +71,83 @@ describe('ETag cache', () => {
     });
     expect(cached2.statusCode).toBe(200);
   });
+
+  test('inscriptions index cache control', async () => {
+    await db.insertInscriptionGenesis({
+      inscription: {
+        genesis_id: '9f4a9b73b0713c5da01c0a47f97c6c001af9028d6bdd9e264dfacbc4e6790201i0',
+        mime_type: 'text/plain',
+        content_type: 'text/plain;charset=utf-8',
+        content_length: 5,
+        content: '0x48656C6C6F',
+        fee: 705n,
+      },
+      location: {
+        inscription_id: 0,
+        block_height: 778575,
+        block_hash: '00000000000000000002a90330a99f67e3f01eb2ce070b45930581e82fb7a91d',
+        tx_id: '9f4a9b73b0713c5da01c0a47f97c6c001af9028d6bdd9e264dfacbc4e6790201',
+        address: 'bc1pscktlmn99gyzlvymvrezh6vwd0l4kg06tg5rvssw0czg8873gz5sdkteqj',
+        output: '9f4a9b73b0713c5da01c0a47f97c6c001af9028d6bdd9e264dfacbc4e6790201:0',
+        offset: 0n,
+        value: 10000n,
+        timestamp: 1676913207,
+        sat_ordinal: 257418248345364n,
+        sat_rarity: 'common',
+        genesis: true,
+        current: true,
+      },
+    });
+    await db.insertInscriptionGenesis({
+      inscription: {
+        genesis_id: '38c46a8bf7ec90bc7f6b797e7dc84baa97f4e5fd4286b92fe1b50176d03b18dci0',
+        mime_type: 'image/png',
+        content_type: 'image/png',
+        content_length: 5,
+        content: '0x48656C6C6F',
+        fee: 2805n,
+      },
+      location: {
+        inscription_id: 0,
+        block_height: 775617,
+        block_hash: '00000000000000000002a90330a99f67e3f01eb2ce070b45930581e82fb7a91d',
+        tx_id: '38c46a8bf7ec90bc7f6b797e7dc84baa97f4e5fd4286b92fe1b50176d03b18dc',
+        address: 'bc1p3cyx5e2hgh53w7kpxcvm8s4kkega9gv5wfw7c4qxsvxl0u8x834qf0u2td',
+        output: '38c46a8bf7ec90bc7f6b797e7dc84baa97f4e5fd4286b92fe1b50176d03b18dc:0',
+        offset: 0n,
+        value: 10000n,
+        timestamp: 1676913207,
+        sat_ordinal: 257418248345364n,
+        sat_rarity: 'common',
+        genesis: true,
+        current: true,
+      },
+    });
+
+    // ETag response
+    const response = await fastify.inject({
+      method: 'GET',
+      url: '/inscriptions',
+    });
+    expect(response.statusCode).toBe(200);
+    expect(response.headers.etag).not.toBeUndefined();
+    const etag = response.headers.etag;
+
+    // Cached
+    const cached = await fastify.inject({
+      method: 'GET',
+      url: '/inscriptions',
+      headers: { 'if-none-match': etag },
+    });
+    expect(cached.statusCode).toBe(304);
+
+    // Simulate new chain tip
+    await db.updateChainTipBlockHeight({ blockHeight: 5 });
+    const cached2 = await fastify.inject({
+      method: 'GET',
+      url: '/inscriptions',
+      headers: { 'if-none-match': etag },
+    });
+    expect(cached2.statusCode).toBe(200);
+  });
 });