The Anatomy of the Greater Occipital Nerve: Part II. Compression Point Topography

Abstract

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.

Emergence of Secondary Trigger Sites after Primary Migraine Surgery

“…16,21,23 This variability makes it prudent to deactivate all active components of even a single trigger site along the course of the nerve, as advocated by prior anatomical studies. 16,19 For example, the migraine headache emerging from the conventional greater occipital nerve could be eliminated on a given patient, yet there could be migraine headache arising from one of the terminal branches of this nerve that crosses a branch of the occipital artery. However, new surgical techniques to address different anatomical compression points must be carefully studied.…”

“…[16][17][18] Many anatomical studies have established that these trigeminal or occipital branches can be entrapped or compressed within muscle, fascial bands, bony foramina or, most commonly, an adjacent vessel. 16,[18][19][20] This irritation causes the release of proinflammatory neuropeptides such as substance P, calcitonin gene-related peptide, and neurokinin A in the neuron cell bodies, resulting in a localized meningitis and subsequent headache. 21 However, a given patient can have migraines originating from multiple peripheral compression points.…”

A Review of Current Evidence in the Surgical Treatment of Migraine Headaches

“…The predominant area of compression was originally described at the intersection of the GON and the semispinalis capitis muscle although a total of 6 areas of compression have subsequently been elucidated. 22 Decompression should be performed proximally to at least the level of the oblique capitis inferioris muscle. A segment of the semispinalis capitis is removed, approximately 1 cm wide and 2.5 cm in length, medial to the GON.…”

Discussion

“…The collective recent interest in the management of head and neck pain, which is often related to peripheral mechanisms, provides a proper platform and rationale for this study. Although our studies have demonstrated the constriction points along the occipital nerve, [1][2][3][4][5][6][7][8][9] the reality is that the specific mechanism underlying occipital neuritis as opposed to migraine headaches is not clearly understood. This article by Ducic et al convincingly negates any possibility of occipital neuritis being related to an inflammation of the occipital artery.…”