The Anatomy of the Occipital Nerves

The occipital nerves are a group of nerves that originate in the cervical spine and innervate (energize) the occipital area (the area along the back of the neck, and sides and back of the head).

The occipital nerves’ primary function is to deliver sensory information to the skin on the back and side of the scalp and the skin of the external ear.

This article examines the anatomy and function of the occipital nerves, symptoms, causes, diagnosis, and treatment of related conditions.

Anatomy

Nerves deliver messages, or impulses, between the brain and the body through the spinal cord, a column of nerve fibers that runs through the backbone (vertebral column). The occipital nerves are a group of nerves that branch from the C2 and C3 spinal nerves, which help control the neck and head.

There are three primary occipital nerves:

• Greater occipital nerve
• Lesser occipital nerve
• Third (least) occipital nerve

All three occipital nerves are located in the neck and scalp regions and have branches that allow them to communicate with each other. The nerves also have cutaneous branches that supply nerve signals to the skin.

Location

The greater occipital nerve branches from the C2 spinal nerve in the upper neck. The nerve travels between muscles along the back of the neck. It emerges through the trapezius (back) and sternocleidomastoid (front base of the neck to under the ear) muscles near where they attach to the occipital bone (back of the head). The nerve continues to the back of the scalp. The greater occipital nerve sometimes reaches the forehead but does not go as far as the face.

The greater occipital nerve’s cutaneous branches run to the back of the scalp, skin of the external ear, and skin over the parotid (salivary) gland.

The lesser occipital nerve runs along the sternocleidomastoid muscle, travels up toward the skull, and emerges at the occipital bone. The lesser occipital nerve has auricular, mastoid, and occipital cutaneous branches, which provide sensation to the front of the scalp and skin of the external ear.

The third occipital nerve is the superficial (surface) branch of the C3 medial branch and travels up the back of the neck toward the skull. It ends with cutaneous branches in the neck’s nuchal (posterior) region.

Function

The occipital nerves provide sensation. The greater occipital nerve is the primary sensory nerve to the occipital area. The main function of the occipital nerves is to provide sensory information to the skin over the back and side of the scalp, along with the skin of the external ear.

The third occipital nerve does perform some motor (motion) function for the semispinalis capitis muscle, a deep back muscle on the side of the backbone that runs from the upper back to the occipital bone.

Associated Conditions

Because the greater occipital nerve travels through the muscles, it is a potential source of nerve compression, entrapment, and irritation.

Occipital neuralgia is a condition associated with the occipital nerves. Symptoms include shooting or stabbing pain along the greater occipital nerve. The pain can travel along the back of the head, neck, and scalp and be triggered by turning the head or pushing on the area. The pain is typically on one side, and the site can be so sensitive that it’s difficult to lie down or wash your hair.

Occipital neuralgia can be a primary or secondary headache disorder. Migraines, a primary headache disorder, can also cause similar symptoms. The two conditions can overlap, making it difficult for doctors to determine which one is causing symptoms.

Having only occipital neuralgia is rare, and the condition is often discovered when
seeking medical help for migraines. Occipital nerve pain may be diagnosed with migraines involving the occipital nerve.

Causes of occipital neuralgia include:

• Pinched nerve in the neck
• Prior surgery to the scalp or skull
• Tight muscles that entrap the nerve
• Infection or diseases such as gout or diabetes

Occipital neuralgia is diagnosed with a physical exam, imaging studies such as magnetic resonance imaging (MRI), X-ray, or CT scan, and an occipital nerve block.

Cervicogenic Headache

Occipital neuralgia also shares similar symptoms with cervicogenic headaches. Both are secondary headache disorders and can cause pain in other areas of the head. Due to their similarities in locations and symptoms, determining if the pain is caused by occipital neuralgia, cervicogenic headache, or other headache disorders can be challenging.

Treatment

Treatment for occipital neuralgia usually begins with conservative methods. These treatments can also help with migraines and cervicogenic headaches. They include:

• Massage
• Physical therapy
• Medications including anticonvulsants, nonsteroidal anti-inflammatory drugs, muscle relaxants, and tricyclic antidepressants

Healthcare providers may try an occipital nerve block if these treatments don’t work. During the procedure, your provider will numb the skin, then use a fine needle to inject local anesthetic and steroids into the nerve through the scalp just above the neck.

Healthcare providers might also use other minimally invasive procedures, including botulinum toxin (Botox) injections or pulsed radiofrequency treatment, which uses low-intensity electrical stimulation of nerves to reduce pain.

Some people may be candidates for surgical procedures to release the nerve from surrounding muscles or destroy parts of the nerve. However, these surgeries are often considered a last resort as results can be temporary and cause loss of sensation and other serious side effects.

Summary

The occipital nerves consist of three nerves that travel along the back of the neck and sides and the back of the scalp. Their primary role is to provide sensation to the skin in these areas. Occipital neuralgia, migraines, and cervicogenic headaches are all associated with the occipital nerves. Occipital neuralgia is usually treated first with conservative methods and minimally invasive procedures, including occipital nerve blocks. If these methods don’t work, surgery to release or destroy parts of the nerve can be used but needs to be carefully considered due to potential
side effects.