Greater occipital nerve

The greater occipital nerve is a cutaneous nerve, the thickest in the body, that innervates the skin from the upper neck, over the occiput, up to the vertex of the scalp ^1-3. 

Terminology

The greater occipital nerve has also been known in the past - confusingly - as the nerve of Arnold. But as any student of neuroanatomy knows, the auricular branch of the vagus nerve (X) is usually called Arnold's nerve.

The use of the eponym 'Arnold' for the greater occipital nerve is now felt to be erroneous, based upon a historical misattribution. Therefore, by extension, the use of the term Arnold neuralgia, for occipital neuralgia, is also suspect and should be discarded. This has been written up in a nice, well-researched paper by a couple of Spanish neurologists, which was published in 2019 ⁵. 

Gross anatomy

Origin

The greater occipital nerve arises from the medial branch of the dorsal ramus of C2 ^1-3. By contrast, the lesser occipital nerve arises from the ventral ramus of C2.

Course

The greater occipital nerve emerges between axis (C2) and the obliquus capitis inferior muscle, hooking underneath the later and piercing semispinalis capitis (3 cm inferior and 1.5-2 cm lateral to the occipital protuberance) before ascending deep to trapezius fascia and eventually piercing trapezius (2.5 cm lateral to the occipital protuberance) ³. It continues to ascend to the occiput.

Branches and supply

It may divide into several branches before piercing trapezius. It supplies the skin over the occipital bone and the upper posterior neck.

Relations

The greater occipital nerve runs with the occipital artery in the apex of the posterior triangle ^1-3.

Related pathology

• occipital neuralgia
• occipital origin migraines