The meningeal branch of the mandibular nerve, also called the nervus spinosus, leaves V3 just below the foramen ovale and turns back into the skull through the foramen spinosum alongside the middle meningeal artery. It supplies the dura mater of the middle cranial fossa and, through the petrosquamous fissure, the mucosa of the mastoid air cells. It is the main sensory nerve of the middle fossa dura.
| Origin | Main trunk of the mandibular nerve (V3) just below the foramen ovale |
|---|---|
| Course | Re-enters the middle cranial fossa through the foramen spinosum with the middle meningeal artery and divides into anterior and posterior branches that follow the artery |
| Sensory |
|
The nervus spinosus carries pain from the dura of the middle cranial fossa, so pathology there, such as extradural haematoma, meningioma or dural metastasis, can cause headache felt in the temple. Its dural terminals are part of the trigeminovascular system: release of CGRP and other neuropeptides from these fibres drives the neurogenic dural inflammation thought to underlie migraine pain, the pathway targeted by anti-CGRP antibodies and gepants. Middle meningeal artery embolisation for chronic subdural haematoma also affects the fibres running with the artery. Middle fossa approaches to the internal auditory canal pass through its territory.
Inflammatory or neoplastic disease of the middle fossa dura causes temporoparietal headache through this branch, a pattern that can be mistaken for jaw or dental pain until imaging shows the cause.
Activation of dural trigeminal afferents, including the nervus spinosus, releases CGRP and causes neurogenic inflammation perceived as throbbing headache; anti-CGRP antibodies such as erenumab and fremanezumab reduce attack frequency in many patients.
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