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Neurovascular Compression of the Greater Occipital Nerve: Implications for Migraine Headaches

Janis, Jeffrey E. M.D.; Hatef, Daniel A. M.D.; Reece, Edward M. M.D., M.S.; McCluskey, Paul D. M.D.; Schaub, Timothy A. M.D.; Guyuron, Bahman M.D.

Plastic and Reconstructive Surgery: December 2010 - Volume 126 - Issue 6 - p 1996-2001
doi: 10.1097/PRS.0b013e3181ef8c6b
Reconstructive: Head and Neck: Original Articles

Background: Surgical release of the greater occipital nerve has been demonstrated to be clinically effective in eliminating or reducing chronic migraine symptoms. However, migraine symptoms in some patients continue after this procedure. It was theorized that a different relationship between the greater occipital nerve and occipital artery may exist in these patients that may be contributing to these outcomes. A cadaveric investigation was performed in an effort to further delineate the occipital artery-greater occipital nerve relationship.

Methods: Fifty sides of 25 fresh cadaveric posterior necks and scalps were dissected. The greater occipital nerve was identified within the subcutaneous tissue and its relationship with the occipital artery was delineated. A topographic map of the intersection of the two structures was created.

Results: The greater occipital nerve and occipital artery have an intimate relationship, and crossed each other in 27 hemiheads (54.0 percent). The relationship between these structures when they crossed varied from a single intersection to a helical intertwining.

Conclusions: The greater occipital nerve and occipital artery have an anatomical intersection 54 percent of the time. There are two morphologic types of relationships between the structures: a single intersection point and a helical intertwining. Vascular pulsation may cause irritation of the nerve and is a possible explanation for migraine headaches that have the occipital region as a trigger point. Future imaging studies and clinical investigation is necessary to further examine the link between anatomy and clinical presentation.

Dallas and Houston, Texas; and Cleveland, Ohio

From the Department of Plastic Surgery of University of Texas Southwestern Medical Center, Baylor College of Medicine, and the Department of Plastic Surgery, Case Western Reserve University School of Medicine.

Received for publication January 7, 2009; accepted May 18, 2010.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Jeffrey E. Janis, M.D., Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas 75390-9132,

©2010American Society of Plastic Surgeons