Lesser Occipital Nerve
Original Editor - Wendy Snyders
Top Contributors - Wendy Snyders, Kim Jackson and Dilawar Singh Maan
Description[edit | edit source]
The lesser occipital nerve (LON), together with the greater occipital nerve (GON) and third occipital nerve innervate the occipital scalp[1]. Its location is highly variable but it reliably emerges from the posterior border of the sternocleidomastoid muscle[2][3]. It then penetrates the deep cervical fascia and superior to the occiput, it communicates with the GON and innervates the skin[3]. The LON has been implicated in patients with occipital headaches[1][4].
Root[edit | edit source]
The root is the lateral branch of the dorsal rami of the C2 and/or C3 spinal nerves[1][2][3].
Branches[edit | edit source]
It has three branches[3]:
- auricular
- mastoid
- occipital
Function[edit | edit source]
Sensory[edit | edit source]
It provides the sensory innervation to the skin of the lateral neck, superior ear and postauricular skin[2].
Clinical relevance[edit | edit source]
Compression of the LON can lead to occipital neuralgia. Occipital neuralgia (C2 neuralgia) presents with paroxysmal shooting/stabbing pain in the dermatomes of the occipital nerves[6][7]. The LON is involved in 10% of cases and GON is involved in 90% of cases[6]. Compression of the GON and/or LON can be due to various things. The table below summarises the possible etiologies:
Assessment[edit | edit source]
According to the International Classification of Headache Disorder (ICHD-III), occipital neuralgia (ON) falls in to the Neuropathies & Facial Pains and other headaches category and the diagnostic criteria as as follows[7]:
A: Unilateral or bilateral pain in the distribution(s) of the greater, lesser and/or third occipital nerves and fulfilling criteria B-D
B: Pain has at least two of the following three characteristics:
- recurring in paroxysmal attacks lasting from a few seconds to minutes
- severe in intensity
- shooting, stabbing or sharp in quality
C: Pain is associated with both of the following:
- dysaesthesia and/or allodynia apparent during innocuous stimulation of the scalp and/or hair
- either or both of the following:
- a) tenderness over the affected nerve branches
- b) trigger points at the emergence of the greater occipital nerve or in the distribution of C2
D: Pain is eased temporarily by local anaesthetic block of the affected nerve(s).
E: Not better accounted for by another ICHD-3 diagnosis.
Treatment[edit | edit source]
Resources[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Lee M, Brown M, Chepla K, Okada H, Gatherwright J, Totonchi A, Alleyne B, Zwiebel S, Kurlander D, Guyuron B. An anatomical study of the lesser occipital nerve and its potential compression points: implications for surgical treatment of migraine headaches. Plastic and reconstructive surgery. 2013 Dec 1;132(6):1551-6.
- ↑ 2.0 2.1 2.2 Dash KS, Janis JE, Guyuron B. The lesser and third occipital nerves and migraine headaches. Plastic and reconstructive surgery. 2005 May 1;115(6):1752-8.
- ↑ 3.0 3.1 3.2 3.3 Yu M, Wang SM. Anatomy, Head and Neck, Occipital Nerves. [Updated 2022 Oct 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542213/
- ↑ Peled ZM, Pietramaggiori G, Scherer S. Anatomic and compression topography of the lesser occipital nerve. Plastic and Reconstructive Surgery Global Open. 2016 Mar;4(3).
- ↑ Choi I, Jeon SR. Neuralgias of the head: occipital neuralgia. Journal of Korean Medical Science. 2016 Apr 1;31(4):479-88.
- ↑ 6.0 6.1 Choi I, Jeon SR. Neuralgias of the head: occipital neuralgia. Journal of Korean Medical Science. 2016 Apr 1;31(4):479-88.
- ↑ 7.0 7.1 13.4 occipital neuralgia (2018) ICHD. International Headache Society. Available at: https://ichd-3.org/13-painful-cranial-neuropathies-and-other-facial-pains/13-4-occipital-neuralgia/ (Accessed: March 21, 2023).
- ↑ Choi I, Jeon SR. Neuralgias of the head: occipital neuralgia. Journal of Korean Medical Science. 2016 Apr 1;31(4):479-88.
