The nervus spinosus (ramus meningeus of V3) is the recurrent meningeal branch of the mandibular division of the trigeminal nerve (V3), re-entering the skull through the foramen spinosum alongside the middle meningeal artery to supply the dura mater of the middle cranial fossa, the mastoid air cells, and the mucosa of the mastoid air cells. It provides the sensory innervation of the temporal and parietal dura that mediates the headache from meningeal irritation and is implicated in migraine pathophysiology.
The nervus spinosus and its dural innervation are central to the trigeminovascular theory of migraine: activation of trigeminal afferents in the dura (via nervus spinosus from V3) and similar branches from V1 releases CGRP from the nerve terminals, producing neurogenic dural inflammation perceived as throbbing headache. Anti-CGRP therapies (erenumab, fremanezumab, rimegepant) target this pathway. Middle meningeal artery embolisation for chronic subdural haematoma incidentally ablates the accompanying nervus spinosus fibres and may contribute to pain reduction in that context.
Cortical spreading depression activates trigeminovascular afferents including the nervus spinosus branches in the temporal and parietal dura, releasing CGRP and substance P from the terminals to produce neurogenic inflammation and the pounding throbbing headache of migraine; anti-CGRP monoclonal antibodies targeting this trigeminovascular activation reduce monthly migraine frequency by 50% or more in responders.
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