Suboccipital Muscles Trigger Points

Introduction

The suboccipital muscles are a group of four deep neck muscles responsible for head extension, rotation, and posture stabilization. When trigger points develop in these muscles, they can cause headaches, neck tension, and dizziness, often mimicking tension headaches, migraines, or cervical spine dysfunction.

Name and Area

  • Name: Suboccipital Muscles (Rectus Capitis Posterior Major, Rectus Capitis Posterior Minor, Obliquus Capitis Superior, Obliquus Capitis Inferior)

  • Area: Located at the base of the skull, connecting the cervical spine (C1–C2) to the occipital bone.

Indications

Suboccipital trigger points may contribute to:

  • Pain at the Base of the Skull That Spreads to the Forehead and Behind the Eyes (Mistaken for Migraines or Tension Headaches)

  • Pain or Tightness in the Neck That Limits Head Rotation (Can Mimic Cervical Spine Dysfunction)

  • Dizziness or Lightheadedness (May Resemble Inner Ear Dysfunction or Vestibular Issues)

  • Eye Strain or Visual Disturbances (Common in Those Who Spend Long Hours on Screens)

  • Pain That Feels Worse in the Morning or After Sleeping in an Awkward Position

  • Increased Sensitivity to Bright Light or Screens (Can Resemble Migraine Symptoms)

Pain from these muscles is often mistaken for tension headaches, cervicogenic headaches, or upper cervical spine dysfunction.

Muscle Action

  • Extends the Head: Tilts the chin upward, essential for gaze control and head posture.

  • Rotates the Head: Allows small, fine movements of the head.

  • Stabilizes the Cervical Spine: Maintains head position during movement and posture control.

The suboccipital muscles are crucial for neck function, postural stability, and head coordination.

Signs and Symptoms

Individuals with suboccipital trigger points often report:

  • Pain at the Base of the Skull That Feels Like a "Tight Band" or Deep Ache

  • Headaches That Radiate to the Forehead, Temples, or Behind the Eyes

  • Neck Stiffness That Makes It Difficult to Rotate or Tilt the Head

  • Pain or Tension That Increases with Prolonged Computer Work or Reading

  • Dizziness or Balance Issues (Can Mimic Inner Ear Dysfunction or Vertigo)

  • Pain That Worsens with Stress, Poor Posture, or Heavy Shoulder Bags

Pain worsens with forward head posture, prolonged screen time, or repetitive neck movements.

Perpetuating Factors

Common causes of suboccipital trigger points include:

  • Forward Head Posture (Common in Desk Workers, Gamers, and Smartphone Users)

  • Chronic Stress or Anxiety (Can Lead to Increased Neck and Shoulder Tension)

  • Sleeping in an Awkward Position (Can Cause Morning Stiffness and Neck Pain)

  • Excessive Screen Time Without Proper Breaks (Strains the Neck and Upper Back Muscles)

  • Whiplash Injuries or Sudden Head Movements (Can Trigger or Aggravate Existing Muscle Tension)

Trigger Point Referral Pattern

Trigger points in the suboccipital muscles refer pain to:

  • The base of the skull and forehead (Can Mimic Cervicogenic Headaches or Neck Stiffness)

  • The temples and behind the eyes (Mistaken for Migraines or Sinus Headaches)

  • The upper cervical spine (Can Resemble Upper Neck Tension or Poor Posture Strain)

Pain from these muscles is often confused with tension headaches, cervical spine dysfunction, or vestibular issues.

Differential Diagnosis

Suboccipital trigger points may be mistaken for:

  • Tension Headaches (Dull, Aching Pain That Wraps Around the Head, Worsens with Stress or Poor Posture)

  • Migraines (Severe, Pulsating Headaches That May Include Light Sensitivity and Nausea)

  • Cervical Radiculopathy (Neck Pain That Radiates to the Shoulder and Arm Due to Nerve Compression)

  • Vestibular Dysfunction (Dizziness and Balance Issues, Can Be Mistaken for Inner Ear Disorders)

  • Occipital Neuralgia (Sharp, Shooting Pain at the Base of the Skull, Often Related to Nerve Compression)

A thorough cervical spine, head, and postural assessment is necessary to rule out these conditions.

Associated Trigger Points

Suboccipital trigger points often co-exist with:

  • Sternocleidomastoid (SCM) (Neck and Head Pain, Can Mimic Migraines or Sinus Pressure)

  • Upper Trapezius (Neck and Shoulder Tension, Common in Forward Head Posture and Chronic Stress)

  • Splenius Capitis (Neck and Head Pain, Can Resemble Migraines or Cervicogenic Headaches)

  • Levator Scapulae (Neck and Shoulder Blade Stiffness, Common in Postural Imbalances and Chronic Tension)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Rectus Capitis Posterior Major Spinous process of C2 Occipital bone Suboccipital nerve (C1)
Rectus Capitis Posterior Minor Posterior tubercle of C1 Occipital bone Suboccipital nerve (C1)
Obliquus Capitis Superior Transverse process of C1 Occipital bone Suboccipital nerve (C1)
Obliquus Capitis Inferior Spinous process of C2 Transverse process of C1 Suboccipital nerve (C1)

The suboccipital muscles are innervated by the suboccipital nerve (C1), which also controls head movement, postural stability, and upper cervical function.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the base of the skull and upper cervical spine.

  • Resisted Neck Extension and Rotation Testing: Assess pain and stiffness when tilting the head backward or turning the head against resistance.

  • Postural Analysis: Look for forward head posture, rounded shoulders, or excessive cervical strain.

  • Occipital Mobility Testing: Rule out nerve compression, cervical spine misalignment, or muscular imbalances.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the suboccipital muscles, reducing neck stiffness and improving head mobility.

Manual Therapy

  • Trigger Point Release: Apply gentle sustained pressure along the posterior neck and base of the skull.

  • Myofascial Release: Helps improve circulation and reduce muscle tension in the upper cervical region.

Stretching

  • Chin Tuck Stretch: Helps lengthen the suboccipital muscles and reduce forward head posture.

  • Seated Neck Rotation Stretch: Rotate the head slowly side to side to improve mobility and reduce stiffness.

Strengthening Exercises

  • Chin Tucks (Neck Postural Training): Helps reduce forward head posture and improve cervical alignment.

  • Scapular Retraction Drills: Strengthens the upper back to counteract excessive neck strain.

Postural and Behavioral Adjustments

  • Avoid Prolonged Forward Head Posture (Keep Screens at Eye Level to Reduce Neck Strain)

  • Use Proper Ergonomics While Sitting (Ensure Good Posture and Shoulder Alignment)

  • Practice Deep Diaphragmatic Breathing (Reduces Chronic Neck and Upper Back Tension)

Conclusion

The suboccipital muscles play a crucial role in head movement, postural control, and upper cervical stability, but trigger points in these muscles can cause significant headaches, dizziness, neck stiffness, and eye strain. By incorporating dry needling, manual therapy, stretching, and postural correction, individuals can reduce pain, improve mobility, and prevent chronic neck dysfunction.

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.