Dallas and Houston, Texas; Washington, D.C.; and Cleveland, Ohio From the Departments of Plastic Surgery of the University of Texas Southwestern Medical Center, Baylor College of Medicine, Georgetown University Medical Center, and Case Western Reserve University School of Medicine.
Plast Reconstr Surg. 2010 Nov;126(5):1563-1572. doi: 10.1097/PRS.0b013e3181ef7f0c.
Advances in the understanding of migraine trigger points have pointed to entrapment of peripheral nerves in the head and neck as a cause of this debilitating condition. An anatomical study was undertaken to develop a greater understanding of the potential entrapment sites along the course of this nerve.
The posterior neck and scalp of 25 fresh cadaveric heads were dissected. The greater occipital nerve was identified within the subcutaneous tissue above the trapezius and traced both proximal and distal. Its fascial, muscular, and vascular investments were located and accurately measured relative to established bony landmarks.
Dissection of the greater occipital nerve revealed six major compression points along its course. The deepest (most proximal) point was between the semispinalis and the obliquus capitis inferior, near the spinous process. The second point was at its entrance into the semispinalis. The previously described "intermediate" point was at the nerve's exit from the semispinalis. A fourth point was located at the entrance of the nerve into the trapezius muscle. The fifth point of compression is where the nerve exits the trapezius fascia insertion into the nuchal line. The occipital artery often crosses the nerve, and this frequently occurs in this distal region of the trapezius fascia, which is the final point.
There are six compression points along the greater occipital nerve. These can be located using the data from this study, serving as a guide for surgeons interested in treating patients with migraine headaches originating in these areas. Long-term relief from migraine headaches has been demonstrated clinically by using both noninvasive and surgical decompression of these points.
对偏头痛触发点的认识的进步指出，头部和颈部的外周神经受压是导致这种使人虚弱的疾病的原因。进行了一项解剖学研究，以更深入地了解该神经沿线潜在的受压部位。
对 25 个新鲜尸体头颅的后颈部和头皮进行解剖。在斜方肌上方的皮下组织中识别出枕大神经，并对其近端和远端进行追踪。定位其筋膜、肌肉和血管的投资，并相对于已建立的骨性标志进行准确测量。
枕大神经的解剖显示，在其走行过程中有六个主要的压迫点。最深（最靠近近端）的点位于半棘肌和头下斜肌之间，靠近棘突。第二个点在其进入半棘肌处。之前描述的“中间”点在神经离开半棘肌处。第四个点位于神经进入斜方肌的入口处。第五个压迫点位于神经离开斜方肌筋膜进入项线的位置。枕动脉经常穿过神经，而这通常发生在斜方肌筋膜的远端区域，即最后一个点。
枕大神经有六个压迫点。可以使用本研究的数据定位这些点，为有兴趣治疗这些区域起源的偏头痛患者的外科医生提供指导。通过对这些点进行非侵入性和手术减压，已在临床上证明可以长期缓解偏头痛。
