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Acupuncture for Suboccipital Muscles

Theodore Levarda

Suboccipital pain can cause headaches

What are the suboccipital muscles?

  • Rectus capitis posterior major

  • Rectus capitis posterior minor

  • Obliquus capitis superior

  • Obliquus capitis inferior

The suboccipital muscles are a group of four muscles located just below the base of the skull. These muscles play a crucial role in head movement and are often a common source of headaches and neck pain. In this blog post, we will delve into the anatomy and function of the suboccipital muscles, their trigger points, and discuss how acupuncture and dry needling can offer relief.

Anatomy of Suboccipital Muscles

Rectus Capitis Posterior Minor

Origin: Tubercle of posterior arch of the atlas (C-1)

Insertion: Inferior nuchal line of the occiput

Action: Rock and tilt the head back into extension

This muscle attaches the top of the cervical spine (C-1) to the occiput and is important in in allowing the head to rock and tilt back.

Rectus Capitis Posterior Major

Origin: Spinous process of the axis (C-2)

Insertion: Inferior nuchal line of the occiput

Action: Rock and tilt the head back into extension, rotate the head to same side

This muscle connects the spinous process of the axis to the lateral part of the inferior nuchal line of the occiput. Since it attaches lower on the cervical spine it also helps rotate the head in addition to rocking and tilting it.

Obliquus Capitis Superior

Origin: Transverse process of the atlas (C-1)

Insertion: Between the nuchal lines of the occiput

Action: Rock and tilt the head back into extension, laterally flex the head to same side

This muscle runs almost vertically, attaching below to the transverse process of the atlas and extending to the nuchal lines of the occiput. Since it runs laterally it also helps to laterally flex the neck.

Obliquus Capitis Inferior

Origin: Spinous process of the axis (C-2)

Insertion: Transverse process of the atlas (C-1)

Action: Rotate the head to same side

This is the only suboccipital muscle that does not attach to the skull. It connects the first two cervical vertebrae, specifically the spinous process of the axis and the transverse process of the atlas. This allows it to rotate the head to the same side.

Suboccipital Triangle

The suboccipital triangle is formed by three of the suboccipital muscles: the two obliqui and the rectus capitis posterior major. This triangular space is crucial as it houses the vertebral artery and the greater occipital nerve.

Function of Suboccipital Muscles

These muscles are responsible for various head movements, including rocking, tilting, rotation, and side bending. They work in synergy with other muscles like the semispinalis capitis for extension and the splenius capitis for rotation. Their function is distinct from the movement of the cervical spine itself.

Suboccipital Trigger Points

Suboccipital muscles trigger points

Suboccipital Trigger Point Indications

  • Headaches or Migraines

  • Back of Head Pain

  • Temple and Eyebrow Pain

  • Temporal Headache (Temples)

According to Travell and Simons, trigger points in the suboccipital muscles are often indicated by headaches that seem to radiate from the occiput towards the eye and forehead. These headaches are often described as "ghostly" due to their poorly defined nature. People with suboccipital trigger points are often diagnosed as having occipital neuralgia.

Signs and Symptoms

Common symptoms include headaches that feel deeply seated in the upper neck region and are more laterally located than those from other posterior cervical muscles. There may also be difficulty rotating the head.

Patients often describe the pain as hurting "all over," but upon careful questioning, most indicate that the pain extends forward unilaterally to the occiput, eye, and forehead.

Suboccipital muscle pain can involve the suboccipital region, including the suboccipital nerve, and the occipital bone. It can also cause long term tension headaches that can feel like pressure in the side of the head.

Causes of Suboccipital Pain

Trigger points are often activated by poor posture, such as a forward-head posture with a posteriorly rotated occiput, or by sustained head tilt and rotation. Other factors include muscle overload and chilling of the neck when the muscles are fatigued.

Suboccipital Trigger Point Referral Pattern

The pain from these trigger points generally refers pain to the occipital and temporal areas of the head. The pain tends to have a lack of clearly definable limits, often radiating towards the eye and forehead. Patients may complain of a headache that feels like it is all over. The pain can also feel similar to pain caused by the semispinalis muscle.

Differential Diagnosis

It's essential to differentiate between occipitoatlantal, atlantoaxial, and C2 articular dysfunctions, which require specific examination techniques. These trigger points can often be mistaken for tension-type headaches, cervicogenic headaches, or occipital neuralgia.

Associated TrPs

Trigger points in the suboccipital muscles often develop as satellites of trigger points in other neck muscles, perpetuating each other cyclically, especially in patients with chronic pain. There are usually other trigger points in other posterior cerivical muscles when there are suboccipital trigger points.

Suboccipital pain tends to feel deep in the upper neck and is felt more laterally than posterior cerivical muscle pain.

Synergists

The major synergists for these muscles include the semispinalis capitis for extension and the splenius capitis for rotation.

Antagonists

The primary antagonists to the suboccipital muscles include the longus capitis and rectus capitis anterior for extension, and the sternocleidomastoid for rotation.

How Can Acupuncture and Dry Needling Help?

Both acupuncture and dry needling can be effective in releasing the trigger points in the suboccipital muscles. Since they are deeper that the superficial posterior neck muscle, using an acupuncture needle provides an effective way to access these muscles.

Releasing suboccipital muscle tension can alleviate the symptoms of occipital neuralgia and improve the range of motion in the neck and head.

One study found that dry needling of the suboccipital muscles reduced headaches, relieved pain, and improved cervical range of motion.

Conclusion

Understanding the anatomy and function of the suboccipital muscles is crucial for diagnosing and treating headaches and neck pain effectively. Acupuncture and dry needling offer effective treatments for suboccipital muscle release, providing relief from headaches and neck pain.

Over to you

If you liked this article, please share with friends and family who may be suffering with headaches or neck pain.

Sources:

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