Suboccipital muscles

The suboccipital muscles are four small, deep muscles at the very top of the neck, just below the back of the skull. They connect the skull to the first two neck vertebrae, support the head and neck, and help extend and turn the head (George & Tadi, 2023).

Where are the suboccipital muscles?

“Suboccipital” means below the occipital bone, the bone at the back of the skull. There are four on each side (TeachMeAnatomy):

• Rectus capitis posterior major, from the second neck vertebra (C2) to the skull.
• Rectus capitis posterior minor, from the first neck vertebra (C1) to the skull.
• Obliquus capitis superior, from C1 to the skull.
• Obliquus capitis inferior, from C2 to C1. It is the only one of the four with no attachment to the skull.

They lie under a larger muscle at the back of the neck, the semispinalis capitis, and are supplied by the suboccipital nerve from the first level of the cervical spine (TeachMeAnatomy; George & Tadi, 2023). Three of them frame a small space called the suboccipital triangle, through which the vertebral artery passes (George & Tadi, 2023). The vertebral arteries help supply blood to the back of the brain (Rahman & Das, 2023).

What do the suboccipital muscles do?

They extend the head, tipping it back, and rotate it, and they give postural support to the head and neck (George & Tadi, 2023; TeachMeAnatomy).

They are also sensors. The deep muscles of the human neck contain an extremely high density of muscle spindles, the receptors that tell the brain about muscle length and movement (Liu et al., 2003). A study of suboccipital muscles from foetal tissue found high spindle counts, and the authors note that signals from the neck muscles play an important role in coordinating the head and eyes and in posture (Kulkarni et al., 2001). So these muscles matter as much for feedback as for movement.

Why do they ache in people who work at screens?

The research link is mainly with headaches and head position:

• Head posture and tension-type headache. In 20 people with chronic tension-type headache and 20 without, 65% of the headache group had active trigger points in the suboccipital muscles, significantly more than the controls. The headache group also held their heads further forward, and the further forward the head, the more often the headaches came (Fernández-de-las-Peñas et al., 2006).
• A link to the spinal cord’s covering. The rectus capitis posterior minor is joined by a bridge of connective tissue to the dura, the tough membrane around the spinal cord. This was found in all 11 specimens examined (Hack et al., 1995), and it is one reason these muscles are thought to play a part in headaches that start in the neck (George & Tadi, 2023).

Both findings need care. The headache study was small and can’t show which came first, and trigger points are a disputed idea (Quintner et al., 2015). The dura connection comes from dissections: it shows a possible route, not a proven cause.

For desk workers, the practical link is forward head posture, where the head drifts ahead of the shoulders. Screen height and distance are covered in the guide to monitor setup.

Which conditions involve the suboccipital muscles?

• Tension-type headache, the most common type of primary headache. It is usually a pressing or tightening, band-like pain on both sides of the head, and people often have tender muscles (Shah et al., 2024).
• Cervicogenic headache, a one-sided headache that starts in the neck, often after neck movement, usually with reduced movement of the neck (Al Khalili et al., 2022).
• Neck pain from desk work, where the larger trapezius and, at the front, the sternocleidomastoid are also often involved.

When should you see a doctor?

Call 999 or go to A&E if a headache starts suddenly and is extremely painful, or comes with numbness or weakness, difficulty speaking, confusion, a very high temperature with a stiff neck, or sensitivity to bright light. Ask for an urgent GP appointment or contact NHS 111 if a headache comes with vision problems, is made worse by coughing or bending, or comes with jaw pain when eating or a tender scalp. See a GP if you get headaches regularly or self-care isn’t helping (NHS).

Gentle work for the top of the neck, where these muscles sit, is part of Bavelu’s neck sessions, designed and filmed by physiotherapists. The app’s AirPods posture tracking also lets you know when your head starts to lean forward.