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.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: : The lesser occipital nerve (LON) is an ascending superficial branch of the cervical plexus that has a variable origin either from the ventral ramus of the second cervical nerve or second and third cervical nerves and is purely sensory. Forty fetuses (right side: 40/80; left: 40/80) with gestational ages between 15 to 28 weeks were microdissected to document the anatomy of the LON. Results: a) Incidence and Morphometry: LON present in 100% specimens, with average length on the right and left sides of 23.59 ± 2.32 mm and 23.45 ± 2.27 mm, respectively; b) Course: In its ascent towards the occipital region, the LON was located on the splenius capitus muscle in 85% of specimens and in 15% of the specimens, it ascended vertically on the sternocleidomastoid muscle towards the ear, innervating its superior third; c) Branching pattern: LON displayed (i) single: 70%; (ii) duplicate: 26% and (iii) triplicate: 4% patterns; d) Variation in the course of LON was observed in 6% of the specimens. Knowledge of the anatomy and variations of the LON may assist in the understanding of cervicogenic headaches and may be of assistance to anesthetists performing regional anesthesia for surgical procedures in the neck. KEY WORDS: Lesser occipital nerve; Superficial branch of the cervical plexus; Cervicogenic headaches.
    International Journal of Morphology 03/2012; 30(1):140-144. · 0.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective.- To test feasibility, safety, and efficacy of local transplant of stromal fraction of adipose tissue in the treatment of chronic headaches of cervical origin. Background.- Chronic headaches of cervical origin (chronic cervicogenic headache and occipital neuralgia) are characterized by persistent pain due to the involvement of the great occipital nerve, with concurrent myofascial spasm and the consequent nerve entrapment within the trapezoid tunnel. Methods.- Tolerability and effectiveness of treatment of chronic cervicogenic headaches refractory to conventional therapies were evaluated in 24 patients. The visual analog scale of pain and the medication use diary were used in the 3 months preceding treatment; moreover, in order to verify the quality of life, patients are required to fill before surgery the Neck Pain Disability Index, the Headache Disability Index, migraine disability assessment scale questionnaire, and the short-form 12 standard v1 questionnaire. Follow-up examination was performed at 3 and 6 months. Results.- In 19 cases (79.2%), a good clinical response was recorded. At 6-month follow-up analysis, recurrence of occipital pain was recorded in 7 cases (29.2%); there is a significant reduction in disability and pain scores, and also a significant reduction of need for pharmacologic treatment and a fast return to previous work capacities. Conclusions.- The key point of our therapeutic strategy might be the regenerative role of stromal fraction of adipose tissue transplanted in the area of the occipital nerve entrapment; the results of the present study are encouraging both in terms of reduction of pain scores and in terms of quality of life improvement. The technique is minimally invasive, and no complications were recorded; indeed, the procedure seems to be safe and effective, and thus, a randomized study with larger follow-up and in a large series will be started.
    Headache The Journal of Head and Face Pain 10/2012; · 2.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: The third occipital nerve is often encountered during the occipital migraine surgery, however its contribution to migraine headaches is unclear. The objective of this study was to determine whether removing the third occipital nerve plays any role in the clinical outcomes of occipital migraine surgery. METHODS: A retrospective comparative review was conducted on all occipital migraine headache (Site IV) patients from 1/2000 to 12/2010. Inclusion criteria were: 1) completion of migraine questionnaire, 2) migraine Site IV decompression, and 3) minimum 6 months of follow-up. Patients were divided into those who had the third occipital nerve removed and those who did not. Outcome variables included overall Migraine Headache Index reduction and Site IV pain elimination. RESULTS: 229 patients met the study inclusion criteria. The third occipital nerve removed group (111 patients) and the third occipital nerve not removed group (118 patients) were comparable in terms of age, gender, number of surgical sites, and statistically well matched regarding preoperative headache characteristics. Comparing the third occipital nerve removed to the third occipital nerve not removed group, Migraine headache index reduction was 63% vs. 64%. Patients experiencing migraine headache elimination (third occipital nerve removed 26% vs. third occipital nerve not removed 29%; p = 0.45) and surgery success with at least 50% reduction in migraine headache (third occipital nerve removed 80% vs. third occipital nerve not removed 81%; p = 0.82) were also similar. There was also no difference between the two groups in symptomatic neuroma formation. Site IV specific pain elimination was similar between the two groups (third occipital nerve removed 58% vs. third occipital nerve not removed 64%; p = 0.54). CONCLUSIONS: Removal of the third occipital nerve did not alter migraine surgery success.
    Journal of Plastic Reconstructive & Aesthetic Surgery 06/2013; · 1.44 Impact Factor

Full-text (2 Sources)

Available from
Jun 1, 2014