The lesser and third occipital nerves and migraine headaches.

Akron Summa Health, Akron, Ohio, USA.
Plastic and reconstructive surgery (Impact Factor: 2.74). 06/2005; 115(6):1752-8; discussion 1759-60. DOI: 10.1097/01.PRS.0000161679.26890.EE
Source: PubMed

ABSTRACT Reports of a correlation between relief of migraine headaches and resection of corrugator muscles or injection of botulinum A toxin have renewed interest in finding the cause of migraine headaches and identifying the trigger sites. Four trigger sites have been described. One of these is along the course of the greater occipital nerve. Recent anatomical studies of this nerve have defined its location with respect to external landmarks, leading to new studies with gratifying results. There is a subset of patients who undergo chemodenervation or surgical release of the greater occipital nerve and note improvement or elimination of the symptoms along the greater occipital nerve course but who experience an emergence of migraine headache symptoms laterally. The authors propose the lesser occipital nerve as the source of pain in those who experience headaches laterally and involvement of the third occipital nerve in those who notice residual symptoms in the midportion of the occipital region.
To test this hypothesis anatomically, 20 cadaver heads were dissected to trace the course of the lesser occipital nerve and third occipital nerve and define the location of these nerves with respect to external landmarks. The midline and a line drawn between the inferiormost points of the external auditory canals were used to obtain standardized measurements of these nerves.
The location of emergence of the lesser occipital nerve was determined to be an area centered 65.4 +/- 11.6 mm from midline and 53.3 +/- 15.6 mm below the line between the external auditory canals. The third occipital nerve was found 13.2 +/- 5.3 mm from midline and 62.0 +/- 20.0 mm down from the line between the two external auditory canals.
This information can be used to conduct clinical trials of chemodenervation of these nerves in an attempt to eliminate migraine symptoms in the subset of patients who continue to experience residual symptoms after surgical release of the greater occipital nerve.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Occipital neuralgia can be a debilitating disease and may occur following operative procedures near the occipital and nuchal regions. One nerve of this region, the third occipital nerve (TON), has received only scant attention, and its potential contribution to occipital neuralgia has not been appreciated. Therefore, in the present study the authors aimed to detail the anatomy of this nerve and its relationships to midline surgical approaches of the occiput and posterior neck. Fifteen adult cadavers (30 sides) underwent dissection of the upper cervical and occipital regions. Special attention was given to identifying the course of the TON and its relationship to the soft tissues and other nerves of this region. Once identified superficially, the TON was followed deeply through the nuchal musculature to its origin in the dorsal ramus of C-3. Measurements were made of the length and diameter of the TON. Additionally, the distance from the external occipital protuberance was measured in each specimen. Following dissection of the TON, self-retaining retractors were placed in the midline and opened in standard fashion while observing for excess tension on the TON. Articular branches were noted arising from the deep surface of the nerve in 63.3% of sides. The authors found that the TON was, on average, 3 mm lateral to the external occipital protuberance, and small branches were found to cross the midline and communicate with the contralateral TON inferior to the external occipital protuberance in 66.7% of sides. The TON trunk became subcutaneous at a mean of 5 cm inferior to the external occipital protuberance. In all specimens, the cutaneous main trunk of the TON was intimately related to the nuchal ligament. Insertion of self-retaining retractors in the midline placed significant tension on the TON in all specimens, both superficially and more deeply at its adjacent facet joint. Although damage to the TON may often be unavoidable in midline approaches to the craniocervical region, appreciation of its presence and knowledge of its position and relationships may be useful to the neurosurgeon who operates in this region and may assist in decreasing postoperative morbidity.
    Journal of neurosurgery. Spine 04/2011; 15(1):71-5. · 1.61 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Advances in the understanding of migraine trigger points have pointed to entrapment of peripheral nerves in the head and neck as a cause of this debilitating condition. An anatomical study was undertaken to develop a greater understanding of the potential entrapment sites along the course of this nerve. The posterior neck and scalp of 25 fresh cadaveric heads were dissected. The greater occipital nerve was identified within the subcutaneous tissue above the trapezius and traced both proximal and distal. Its fascial, muscular, and vascular investments were located and accurately measured relative to established bony landmarks. Dissection of the greater occipital nerve revealed six major compression points along its course. The deepest (most proximal) point was between the semispinalis and the obliquus capitis inferior, near the spinous process. The second point was at its entrance into the semispinalis. The previously described "intermediate" point was at the nerve's exit from the semispinalis. A fourth point was located at the entrance of the nerve into the trapezius muscle. The fifth point of compression is where the nerve exits the trapezius fascia insertion into the nuchal line. The occipital artery often crosses the nerve, and this frequently occurs in this distal region of the trapezius fascia, which is the final point. There are six compression points along the greater occipital nerve. These can be located using the data from this study, serving as a guide for surgeons interested in treating patients with migraine headaches originating in these areas. Long-term relief from migraine headaches has been demonstrated clinically by using both noninvasive and surgical decompression of these points.
    Plastic and reconstructive surgery 11/2010; 126(5):1563-72. · 2.74 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Recent investigation has focussed on the concept of peripherally triggered migraine headaches caused by compression, irritation or entrapment of the sensory nerves in the head and neck. We report a case of a 52-year-old male suffering from an occipitoparietal migraine that presented with a mass in the right occipital area. The mass was found in the deep layer of subcutaneous tissue just over the semispinalis muscle, sitting on top of the lesser occipital nerve, which was preserved through delicate dissection using loupe magnification. Histopathological findings of the mass reported benign, reactive hyperplasia of the lymph node. After removal of the mass, the patient reported complete resolution of headaches. Sensation of the scalp was not altered. This is the first report of a case of hyperplastic lymph node causing migraine through physical compression of a peripheral nerve.
    Journal of Plastic Reconstructive & Aesthetic Surgery 05/2011; 64(12):1657-60. · 1.44 Impact Factor

Full-text (2 Sources)

Available from
Jun 1, 2014