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Muscle Monday: Suboccipitals and Headaches



Let’s talk headaches! Chances are high that right now someone reading this is currently experiencing a headache. How can we be so sure about that? Well, many headaches are caused by, or exacerbated by poor sitting posture, which we all typically obtain while sitting at our computers all day or looking down at our phones when perusing social media.

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One group of muscles that is notorious for causing headaches, is the suboccipital muscles.


The suboccipital muscles are composed of four small muscles located very deep in your upper cervical spine. These muscles have an attachment at C1 or C2 and the base of your skull. They are:

1. Rectus capitus posterior major

2. Obliquus Capitus Superior (or superior oblique)

3. Obliquus capitus inferior (or inferior oblique)

4. Rectus capitus posterior minor



The suboccipital muscles make up what’s called the suboccipital triangle. This term came from the fact that……(drumroll please)……yep, you guessed it…they create the shape of a triangle!


Within that triangle, is the suboccipital nerve, which is the nerve that innervates these muscles, and the vertebral artery. Also in the vicinity is the greater occipital nerve. Both of these nerves (and other structures in the area) can cause headaches.


Let’s take the example of a motor vehicle accident: During motor vehicle accidents, whiplash can cause these muscles and nerves to be over-stretched and agitated. When the muscles of the deep neck become damaged and inflamed, they can place pressure on these important nerves. Add in the possibility of the those nerves being stretched…then you have a good reason to complain of unmanageable and very powerful headaches.


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Even more inconvenient is that these muscles and nerves don’t need to sustain an injury to cause headaches. Say what?!? It’s true! Poor posture is a major cause of tightness and imbalances that can create pressure on the nerves in the area, leading to headaches. In fact, muscles all the way down your spine, across your chest, or your shoulder could add to an imbalance causing the suboccipital muscles to become tight, which can lead to irritation of the suboccipital nerve or greater occipital nerve. And before you know it, you’ve got a headache. That’s only the tip of the iceberg of things to make you want to throw an icepack on your head. Even your TMJ can cause you to feel pain in your neck and create headaches, so how do you ever know what is the root of your pain? Read on…


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Who can be at risk for issues related to the suboccipital muscles and resultant headaches?


People involved in motor vehicle accidents, head bangers (we’re looking at you, metalheads), amusement park enthusiasts, and unfortunately everyone who sits at a desk all day, works at a computer, spends time looking down at their phone or lounges around on the couch.


So how do you know what the cause of your headache is or how to treat your suboccipital issues?


To identify the true cause of your headaches and/or suboccipital issue, you really need a full assessment of all of the muscles of your neck, back and possibly your TMJ. At Nashville Physical Therapy, we have physical therapists who can evaluate your cervical spine, headache complaints, TMJ, etc. Following a full assessment we can identify any weak muscles, tight muscles, joint restrictions and movement pattern issues and then provide the specific exercises needed to address the true cause of your dysfunction and/or pain.


Other facts about the suboccipital muscles:


· Physical therapists treat suboccipital muscle issues and headaches in a variety of ways, depending on the specific needs of the patient. Examples of treatment techniques include: manual therapy for joint mobilizations, suboccipital release, massage, contract-relax methods, dry needling, postural exercises, stretching and lots of education!


· Some of the tender points involved in fibromyalgia are in the same region of the suboccipitals.


· The suboccipital muscles help to extend the head and rotate the head.


· The suboccipital muscles are innervated by the suboccipital nerve.


· The rectus capitus posterior major attaches from the spinous process of C2 to the occiput.


· The rectus capitus posterior minor attaches from the spinous process of C1 to the occiput.


· The obliquus capitus superior attaches from the transverse process of C1 to the occiput.


· The obliquus capitis inferior attaches to the spinous process of C2 to the transverse process of C1.



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