The greater occipital nerve is the largest of the three occipital nerves, a branch of the C2 posterior primary ramus that supplies sensation to the posterior scalp all the way to the vertex. It is the most commonly implicated nerve in occipital neuralgia, producing a characteristic unilateral pain that radiates from the occipital base over the scalp toward the eye. Its course through and beneath the semispinalis capitis and trapezius muscles makes it susceptible to entrapment from cervical muscle tension and joint dysfunction.
| Origin | Medial branch of the posterior (dorsal) ramus of C2 |
|---|---|
| Course | Emerges below obliquus capitis inferior, ascends on and then pierces semispinalis capitis and the trapezius aponeurosis near the superior nuchal line, and runs up the posterior scalp with the occipital artery, which lies just lateral to it |
| Motor |
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| Sensory |
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Occipital neuralgia produces severe stabbing or aching pain from the base of the skull over the posterior scalp toward the vertex, often with scalp tenderness to touch. The nerve can be irritated or entrapped where it pierces semispinalis capitis or the trapezius aponeurosis. Pressure over the nerve near the superior nuchal line, just medial to the palpable occipital artery and a few centimetres lateral to the external occipital protuberance, reproduces the pain, and a local anaesthetic block there is both diagnostic and therapeutic. Blocks are also used for cluster headache and migraine. Persistent cases may respond to pulsed radiofrequency treatment or surgical decompression.
Greater occipital nerve entrapment or irritation producing severe unilateral posterior scalp pain radiating from the occipital base to the vertex, confirmed by tender point palpation at the nerve emergence site and relief with diagnostic nerve block.
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