Suboccipital Muscles Referred Pain

The Suboccipital Muscles

The suboccipital muscles are four small muscles located at the bottom of the skull. Though these muscles are small, they can cause and contribute to headaches, eye pain, and contribute to migraine headaches.

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    Suboccipital Muscles

    Where are the suboccipital muscles?

    The suboccipital muscles are a group of four muscles:
    • Obliquus capitis inferior
    • Obliquus capitis superior
    • Rectus capitis posterior major
    • Rectus capitis posterior minor
    The muscles are located on each side of the back of the neck just below the base of the skull. The muscles connect to each other and connect the skull to the top two vertebrae of the neck.

    What Movements Does It Control?

    • Turns the head to the side
    • Tilts the head to the side (ear to shoulder)

      For detailed anatomy information: Suboccipitals Anatomy

    What pain and symptoms are associated with the suboccipital muscles?

    Trigger points in the suboccipital muscles cause pain that makes the entire side of the head hurt. The pain feels as if it is deep in the head which is also a symptom of many migraines. You may also experience a band of pain that starts at the back of the skull and extends into the back of the eye. There is often a band of more intense pain just behind the ear.
    Another common symptom of trigger points in the muscles is stiffness in the neck without pain. You have limited motion in the neck but do not feel pain while turning or bending the neck.

    TWD Recommends

    Suboccipital muscle tightness and pain responds well to hot and cold treatments. The Huggaroo Neck Wrap treats the neck, top of the shoulder, and upper back. Use cold for migraines and whiplash injuries. Use heat for tension headaches and relaxation.

    What causes trigger points in the suboccipital muscles?

    Tilting your head to the side
    Keeping your head tilted toward the shoulder for an extended amount of time shortens the suboccipital muscle group on the side that is tilted toward the shoulder and keeps the suboccipital group on the opposite side in a prolonged stretch.  This creates a muscle imbalance at the base of the skull that tugs at the upper vertebræ in the neck causing headaches, neck pain and stiffness.
    Raising your shoulder and tilting your head to the side is also problematic. Many people have a habit of holding their phone to the ear using their shoulder.  People who enter data on a computer while reading material setting off to the side which requires the head to be continually turned to the side often experience “word-processor” headaches. These actions contribute to headaches, neck pain, and stiffness. It will also lead to the development of trigger points.
    Keeping your head bent back
    Painting, hanging wallpaper, and other activities that require you to bend your head backward to look upward cause tension and trigger point development in the muscles. People who lay on their stomachs and look up at the T.V. or who sit in the front rows at movie theaters often have headaches and/or stiff necks after extended periods of watch time.
    Prolonged stress and emotional tension
    Stress and tension will cause the muscles to shorten and tighten which contributes to headaches and stiffness of the neck.
    Forward head posture
    Forward head posture is when the head extends out in front of the body stretching and extending the neck forward. Forward head posture keeps the suboccipital muscles in a constant stretched out position causing the muscles to become tight and stressed.
    If you have ever suffered a whiplash injury you should check the muscles for trigger points. The whipping motion of the head forward and backward or side to side will cause trigger points to develop.

    TWD Recommends

    Do You Have Headaches That Radiate From Deep In The Head? A Stiff Neck But No Pain?

    These symptoms point to the suboccipital muscles.The Craniocradle was developed to treat headaches and stiff necks. The cradle applies pressure to the muscles while providing gentle traction to the neck. Use for 5-10 minutes and feel a reduction in pain and stress. The cradle can also be used for treatment on other areas including the low back and hip area. Instructions are provided.

    Suboccipital Muscles Trigger Point Treatment

    The suboccipitals are relatively easy to self-treat. The Trigger Point Therapy Workbook is an excellent resource to learn how to find and treat trigger points throughout the body. Though it takes time and some patience to learn how to find and the feel of trigger points, it is time well spent. Once you learn you will be able to self-treat muscle pain throughout the body.
    Another option is to find a massage, sports, or physical therapist with training in the therapy to show you how to locate and treat specific TrPs.
    Trigger points best respond to several short treatments spread throughout the day. It is important to continue treatment until the TrPs can no longer be felt and applied pressure around the area of the trigger point no longer produces pain or symptoms.


    Biofreeze Pain Relieving Gel is an excellent pain-relieving gel and I recommend it for those who have sudden onset muscle pain or recent injuries.  It is better than warm therapy gels and creams for recent injury muscle pain as it cools the area much like ice and does not promote swelling. Biofreeze is recommended for those who have had a recent neck injury or sudden onset pain. Rub Biofreeze into the upper back, shoulders, and into back of the neck going up to the base of the skull and over behind the ears.  Highly recommended for early treatment of whiplash.

    Sombra Warm Therapy Pain Relieving Gel is a pain-relieving gel that I use both personally and professionally in my massage therapy practice. Unlike other over the counter heating creams, it provides warmth without burning heat. It can help reduce tightness and pain in the back of the neck and the base of the skull often caused by the suboccipital muscles. Applying Sombra to the back of the neck, up behind the ears and along the base of the skull will help relax the muscles and provide pain relief.

    TWD Recommends

    Does your pillow support your head and neck?

    Sleeping without proper head and neck support is sure to aggravate neck and shoulder muscles. The Sweetnight Pillow has adjustable filling and is highly recommended for its neck support.

    Interesting facts about the suboccipital muscles

    • The obliquus capitis inferior, obliquus capitis superior and the rectus capitis posterior major are the muscles that make the borders of the suboccipital triangle.
    • It is often said that suboccipital pain feels like it is deep inside the head. The pain is referred to as ‘ghost pain’ because the pain is hard to pin to a specific location and is hard to define.

    Clinical diagnoses to which the suboccipital muscles symptoms may contribute:

    • Headaches
    • Temporomandibular Joint Dysfunction
    • Sinusitis
    • Eye Strain
    • Food Allergies
    • Concussion
    • Post Concussion Syndrome
    • Toothache
    • Mastoiditis


    Other muscles that should be considered and examined in conjunction with the suboccipital muscles:

    Satellite trigger points associated with the muscle:

    If you find trigger points in the suboccipital muscles you will want to check these muscles for additional trigger points.
    • Trapezius
    • Sternocleidomastoid
    • Levator Scapulae
    • Longus Colli
    • Longus Capitis

    I use and often recommend the Neck King Massage Tool For Neck and Back to my clients who suffer from headaches, migraines, and stiff necks. The Neck King works on trigger points and pressure points to help relieve muscle tension and pain. The secret to using the Neck King is to follow the directions carefully and to slowly build up the time spent using the tool. For many first time users the tool is too hard to use comfortably. Folding a hand towel and laying it over the Neck King will help ease the discomfort. It works extremely well on the muscles at the base of the skull. This tool has helped me as well as many of my clients relieve headaches, sore stiff necks, and upper back strain.