Peripheral nerves of the head

Sensation of the head, peripheral nerves

Plexus cervicalis, sensory nerves ramus ventralis C1-4

N. occipitalis minor: C2
N. auricularis major: C2-3
N. transversus colli: C2-3
N. supraclavicularis: C3-4

The nerves emerge at the midpoint of the posterior border of m. sternocleidomastoideus, the so-called punctum nervosum

Sensation of the head, sensory nerves ramus ventralis

Plexus cervicalis, sensory nerves ramus dorsalis

From ramus dorsalis
N. occipitalis major: C2-3
Ramus dorsalis: C3-5

Trigeminal neuralgia

Neuropathic pain in the innervation area of the N. Trigeminus (N. ophthalmicus, N. maxillaris, N. mandibularis)
- Burning pain with sudden onset that can last for several minutes
Causes
- Mechanical pressure on the nerve due to aneurysm, tumor, or trauma
- Postherpetic neuralgia
- Dental disease

Sensory nerve from the dorsal ramus of the cervical nerve N. occipitalis major C2-3

N. occipitalis major neuralgia

The patient complains of constant discomfort/pressure suboccipitally, with episodic experiences of intense pain radiating to the back of the head in the sensory area of the N. occipitalis major
The likely mechanism for the pain is nerve compression and subsequent inflammation in the nerve as it passes through the m. semispinalis and/or m. trapezius
Common symptoms
- Pain on one or both sides of the head
- Pain behind the eyes
- Light sensitivity
- Blurred vision
- Reduced neck mobility
The likelihood that the condition is present can be strengthened by a positive effect of nerve blockade
Differential diagnoses are migraine, tension headache, hemicrania (paroxysmal/continuous/treated with indomethacin) and cluster headache (episodic/continuous/treated with triptans)

Blake, P., Burstein, R. Emerging evidence of occipital nerve compression in unremitting head and neck pain.J Headache Pain 20, 76 (2019). https://doi.org/10.1186/s10194-019-1023-y

NevroNEL

National Advisory Unit on Headache (NKH) St. Olavs Hospital

Cervicogenic headache

Pain distribution, often unilateral

The following sensory nerves contribute to the pain
- Sensory dorsal cervical nerve roots (N. occipitalis major)
- Sensory nerves from the cervical plexus (N. occipitalis minor, N. auricularis major)
Point of maximum pain is in the neck (dark shading)
Referred pain to forehead/temple, as well as down towards the shoulder (light shading)
Accompanying headache is often unilateral