Greater occipital nerve
Medial branch of the dorsal ramus of C2 that supplies the skin of the back of the scalp. Its irritation causes occipital neuralgia, which responds to nerve block.
Core anatomy
- Location
Posterior neck and scalp.
- Root values
C2 (dorsal ramus).
- Origin
Medial branch of the dorsal ramus of C2.
- Course
Emerges below obliquus capitis inferior, curves upward over the suboccipital triangle, pierces semispinalis capitis and then the trapezius aponeurosis near the superior nuchal line, a few centimeters lateral to the external occipital protuberance, and ascends with the occipital artery over the back of the scalp. verify
- Motor
Semispinalis capitis (some fibers).
- Sensory
Skin of the posterior scalp up to about the vertex.
- Relations
The lesser occipital nerve (C2, ventral ramus, via the cervical plexus) supplies the skin behind the ear, and the third occipital nerve (C3 dorsal ramus) supplies the skin of the lower occiput and upper neck.
Other structures innervated
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Clinical correlations
Occipital neuralgia PANCE
- Mechanism / lesion
Irritation or entrapment of the greater (or lesser) occipital nerve, e.g. by muscle tension, trauma or upper cervical disease.
- Classic presentation
Paroxysmal shooting or stabbing pain in the distribution of the nerve (from the occiput toward the vertex), scalp tenderness or dysesthesia, and tenderness over the nerve where it emerges. Temporary relief after a local anesthetic greater occipital nerve block supports the diagnosis.
High-yield PANCE pearls
- Occipital neuralgia: shooting pain from the occiput to the vertex, tender nerve, relief with nerve block.
- Greater occipital = C2 dorsal ramus; lesser occipital = C2 ventral ramus (cervical plexus); third occipital = C3.
Imaging anatomy
- MRI
Usually normal; used to exclude structural causes at the craniovertebral junction.
- Ultrasound
Guides greater occipital nerve block at the superior nuchal line or at obliquus capitis inferior.
- Key views & landmarks
- Diagnostic nerve block (clinical)
Physical exam
- Surface landmarks
About one-third of the distance from the external occipital protuberance to the mastoid process, along the superior nuchal line (next to the palpable occipital artery pulse).
- Palpation
Pressing over the nerve reproduces the pain (sometimes a Tinel-like sign).
- Strength / function testing
Sensory testing of the posterior scalp.
Self-quiz
A 45-year-old woman has brief electric-shock pains radiating from the base of her skull to the top of her head on one side. Pressure over the right occiput reproduces the pain, and a local anesthetic injection there relieves it. Which nerve is involved?
Correct answer: B
Occipital neuralgia involves the greater occipital nerve (C2), which supplies the posterior scalp to the vertex; a nerve block confirms it.
Show answer
B
Occipital neuralgia involves the greater occipital nerve (C2), which supplies the posterior scalp to the vertex; a nerve block confirms it.
The greater occipital nerve is derived from which structure?
Correct answer: B
It is the medial branch of the dorsal ramus of C2. The dorsal ramus of C1 is the suboccipital nerve.
Show answer
B
It is the medial branch of the dorsal ramus of C2. The dorsal ramus of C1 is the suboccipital nerve.
The greater occipital nerve emerges below which muscle?
Correct answer: B
It emerges below obliquus capitis inferior before ascending over the suboccipital triangle.
Show answer
B
It emerges below obliquus capitis inferior before ascending over the suboccipital triangle.