Greater occipital nerve

Andrew Murphy and Dr Craig Hacking et al.

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

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

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.

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.

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

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

Anatomy: Head and neck
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Article information

rID: 53440
System: Head & Neck
Section: Anatomy
Synonyms or Alternate Spellings:
  • Nerve of Arnold (cutaneous)
  • Greater occipital nerve (GON)

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Cases and figures

  • Figure 1: cervical plexus
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  • Figure 2: diagram of the greater occipital nerve
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  • Figure 3: perineural tumor spread along the greater occipital nerve
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