Greater Occipital Nerve Entrapment

nervus occipitalis major — entrapmentum

The greater occipital nerve (posterior ramus of C2) ascends through the semispinalis capitis muscle and pierces the deep fascia below the superior nuchal line, accompanied by the occipital artery, to supply the posterior scalp to the vertex. It can be entrapped as it pierces the fascia of the semispinalis capitis or the trapezius aponeurosis, producing occipital neuralgia.

Region: Neck

Clinical Relevance

Clinical Notes

Greater occipital nerve entrapment at the suboccipital or nuchal fascial level produces occipital neuralgia — unilateral stabbing or burning pain from the posterior neck to the vertex, with point tenderness over the nerve's course at the superior nuchal line and a positive Tinel sign at the entrapment site. Occipital nerve block with local anaesthetic confirms the diagnosis by temporarily abolishing the pain. Chronic cases respond to pulsed radiofrequency treatment or surgical decompression.

Pathology

Common Injuries & Conditions

Occipital Neuralgia

Greater occipital nerve entrapment in the semispinalis capitis fascia produces unilateral occipital shooting pain from the posterior neck to the vertex with characteristic point tenderness just medial to the occipital artery, managed by occipital nerve block with local anaesthetic and corticosteroid as first-line treatment.