The third occipital nerve (TON) is the medial branch of C3 that wraps around and innervates the C2-C3 zygapophyseal joint, the most common source of cervicogenic headache after whiplash. TON blocks and pulsed radiofrequency ablation of the TON target the C2-C3 facet joint specifically. The TON cutaneous territory is suboccipital, just below the GON territory.
| Origin | Medial branch of C3 dorsal ramus, the largest medial branch of the upper cervical dorsal rami |
|---|---|
| Course | Winds around the C2-C3 facet joint capsule, pierces the semispinalis and trapezius to supply the suboccipital skin |
| Motor |
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| Sensory |
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The C2-C3 facet joint innervated by the TON is the most commonly injured cervical facet joint in whiplash, producing the 'headache of C2-C3' that responds to TON blocks. Percutaneous radiofrequency neurotomy of the TON provides 6-12 months of relief from C2-C3 facet-mediated cervicogenic headache.
Third occipital nerve mediated suboccipital and cervical headache from C2-C3 zygapophyseal joint injury managed with TON block and radiofrequency neurotomy.
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