The longissimus capitis is the cranial extension of the longissimus column, arising from the lower cervical articular processes and upper thoracic transverse processes, and inserting on the posterior mastoid process. It is the most lateral of the three muscles inserting on the skull (alongside semispinalis capitis and splenius capitis) and lies deep to the sternocleidomastoid and splenius capitis. It forms part of the erector spinae group and contributes to cervical extension and head positioning.
| Origin | Articular processes of C4 to C7 and transverse processes of T1 to T3 |
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| Insertion | Posterior margin of the mastoid process of the temporal bone |
| Nerve Supply | Posterior rami of cervical spinal nerves (C4-C8) |
| Blood Supply | Deep cervical artery; Occipital artery |
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It extends the head and turns and side-bends it to the same side, assisting head posture and movement.
The longissimus capitis is one of the deep cervical extensors whose dysfunction contributes to chronic neck pain and cervicogenic headache. Its mastoid insertion makes it a contributor to neck posture and head-on-neck control. Posterior cervical approaches for laminectomy and fusion require careful muscle elevation and retraction of longissimus capitis to access the cervical laminae. Myofascial trigger points within this muscle refer pain to the occipital region, temporal region, and behind the eye.
Palpated in the posterior lateral neck, deep to the sternocleidomastoid, running from the upper thoracic transverse processes toward the mastoid tip. Best assessed with the patient prone and head in slight extension.
Myofascial trigger points within the longissimus capitis produce a unilateral posterior and temporal headache that may extend behind the eye, managed with dry needling, cervical manipulation, and deep cervical flexor strengthening to reduce compensatory extensor overactivation.
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