Suboccipital Muscles: Pain & Trigger Points

The suboccipital muscles consist of four small muscles at your cervical spine.

If they are tense or carry active trigger points, they can trigger headaches and restrict the mobility of the neck.

You can relieve these points and tensions yourself. On this page, I’ll show you how.

You will learn …

  • which complaints and pains these muscles cause.
  • where these muscles are located.
  • what functions these muscles perfom.
  • how they get overloaded.
  • how you feel them.
  • how to loosen and massage them.

1. Pain Patterns, Symptoms & Differential Diagnoses

1.1 Pain patterns

Trigger points in the suboccipital muscles can trigger pain on the side of the head that extends from the back of the head towards the eye and forehead.

Many people describe these headaches as “penetrating into the head”.

Additionally, the pain is usually diffuse and cannot be clearly defined.

1.2 Symptoms

Besides pain, there may be hypersensitivity at the back of the head.

Many people with trigger points in these muscles complain that they can no longer place the head on a pillow.

Even the weight of the head on the pillow and the resulting pressure on the muscles might cause severe pain.

2. Attachment Points

The suboccipital muscles can be divided into four muscles.

  • Rectus capitis posterior major
  • Rectus capitis posterior minor
  • Obliquus capitis superior
  • Obliquus capitis inferior

The first three muscles connect your first two cervical vertebrae to the occiput (the back of your head).

The fourth muscle connects the first two cervical vertebrae (Atlas and Axis).

3. Suboccipital Muscles: Functions

The suboccipital muscles move the head in all possible directions. At the same time, they control these movements and coordinate them.

  • Extension of the cervical spine
  • Rotation of the cervical spine
  • Lateral flexion of the cervical spine
  • Combinations of these movements
  • Control of the flexion movement of the cervical spine

4. Suboccipital Muscles: Trigger Point Activation

Trigger points in the suboccipital muscles rarely get activated “alone”, but mostly along with other muscles of the cervical spine, such as the splenius cervicis.

Contributing factors usually are …

  • Permanent contraction during stretching or in a stretched position (eccentric & isometric contraction)
  • Permanent approach/shortening
  • Cold draught

4.1 Permanent contraction

I already mentioned that these muscles control and coordinate the movements of the neck.

This is especially the case when you move the chin towards the chest, i.e. when you bend/flex the cervical spine.

Here, the suboccipital muscles work to prevent the head from tilting forward.

During this movement the muscles lengthen and get stretched, respectively. The muscles work a “against” this stretch by contracting in order to control the movement.

If you tilt your head forward for a long time, the suboccipital muscles must constantly tense in order to stabilize the head, and this can overload them and lead to the activation of trigger points.

We often go into this position, especially while working at the desk or when reading.

4.2 Permanent shortening

If you tilt the head backwards or turn it to the side, the exact opposite happens.

The muscles contract and become “shorter”. If you hold the head in such a position for some time, this can also activate of trigger points. Especially if you move quickly out of the position after a long time (one minute may be enough).


  • Tucking a phone between ear and shoulder.
  • Screen is located to your side.
  • The person you are talking to sits next to you.
  • Painting jobs
  • Climbing

4.3 Cold draught

A cold draught can cause tension and trigger points in these muscles. Especially when they are already tired from work and then held in an shortened position.

A possible scenario:

You renovated your apartment for a few hours and painted the ceiling. Now at the day you cycle in the cool autumn air to a lake and sit down on a bench.

There you take your head in the neck, looking into the sky and enjoying the warming sun.

  • The muscles got tired.
  • The muscles were exposed to a cold draught.
  • The muscles were shortened for a longer time.

What could help here? A scarf would reduce the probability of problems developing in the muscles.

5. Suboccipital Muscles: Palpation

Since the suboccipital muscles are covered by other muscles of the cervical spine, it is very difficult to feel them through “normal movements”.

However, this is no big deal, as you only need to know where to place your hand for the massage – and this is what I’ll show you.

But the muscles co-contract with eye movements. And this you will be able to feel.

It’s not easy but give it chance.

  • Place your index and middle finger on the side of your cervical spine – directly below your skull.
  • Close your eyes.
  • Move the eyes with the eyelid closed, blink with the eyelid closed.
  • Can you feel the suboccipital muscles slightly contracting under your fingers?

Note: Do not press hard into your cervical spine, otherwise you won’t be able to feel the contractions.

6. Suboccipital Muscles: Self-massage

You can massage the muscles with your fingers or with the Trigger Fairy.

As a massage technique you can apply the classic techniques of this site, namely …

  • Ischemic compression
  • Precise massage strokes
  • Pressure-motion technique

I recommend using the Trigger Fairy, as this protects your fingers.

If you don’t have the Trigger Fairy, then that’s no problem. Of course, you can also perform the massage with your fingers. But be careful not to overload them and keep the massage sessions short.

On this page I will show the precise massage strokes with the Trigger Fairy.

6.1 Precise massage strokes with the Trigger Fairy

Hold the Trigger Fairy with both hands. One hand at the top of the bow, one at the bottom of the handle.

Hold the handle in front of your face.

Place the Fairy’s head on the suboccipital muscles, on your cervical spine directly under your skull.

Now you are in the area of the muscles. To massage them, proceed as follows.

  • Press with the Trigger Fairy into the muscles.
  • Perform slow downward movements. That is, strike from top to bottom.
  • This way seek for painful tensions.
  • Once you discover one, massage it a few times with strokes from just before to just after the painful spot.

6.1.1 Two important notes:

To massage the suboccipital muscles, concentrate only on the area directly under your skull and a few centimeters down.

Of course, you can also massage the areas a bit more down below, but then you are no longer on the suboccipital muscles.

Perform the massage gently: The region of your cervical spine is very sensitive, and its muscles can react intensely to a massage, especially if you are not used to it.

A massage that is too strong can irritate receptors for spacial orientation and lead to dizziness.

However, if you take it slowly and listen to your body, these problems usually do not occur.


  • Calais-German, Blandine. Anatomy of Movement. Seattle: Eastland Press, 1993. Print
  • Davies, Clair, and Davies, Amber. The Trigger Point Workbook: Your Self-Treatment Guide For Pain Relief. Oakland: New Harbinger Publications, Inc., Print
  • Simons, David G., Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore, MD: Williams & Wilkins, 1999. Print.
  • Schünke, Michael., Schulte, Erik, and Schumacher, Udo. Prometheus: Lernatlas der Anatomie.Stuttgart/New York: Georg Thieme Verlag, 2007. Print