Suboccipital Muscles

ByA. Mendelson, MD
Please read the disclaimer

When you read a radiology report, you may notice the term “suboccipital muscles.” These small but important muscles are located at the base of the skull, deep in the upper neck. They often appear on MRI or CT scans of the head and neck. Understanding what suboccipital muscles are can help clarify why radiologists mention them in reports.

What Are the Suboccipital Muscles?

The suboccipital muscles are a group of four small muscles that connect the skull to the upper cervical spine. They include:

  • Rectus capitis posterior major

  • Rectus capitis posterior minor

  • Obliquus capitis superior

  • Obliquus capitis inferior

These muscles are important for stabilizing the head and allowing fine movements such as nodding and turning.

Suboccipital Muscles on MRI

  • Normal appearance: They look like small, well-defined muscle bundles at the back of the upper neck, just beneath the skull base.

  • Fatty infiltration: In some patients, especially with chronic pain or age-related changes, muscles may appear smaller and replaced with fat.

  • Edema (swelling): If injured, the muscles may show increased signal (brightness) on fluid-sensitive MRI sequences.

Radiologists often compare both sides to see if changes are symmetric or isolated to one side.

Suboccipital Muscles on CT

On CT scans, these muscles appear as soft tissue shadows along the back of the upper neck. CT is less sensitive for subtle muscle changes but is useful for:

  • Detecting calcification or bone changes around muscle attachments.

  • Evaluating trauma when bone fractures might extend into the skull base or cervical spine.

  • Guiding procedures, such as injections into the suboccipital region for chronic headache relief.

Why Radiologists Mention Them

Radiologists may highlight suboccipital muscles in a report for several reasons:

  1. Headache evaluation – These muscles are closely related to tension headaches and occipital neuralgia. Imaging can show if they are strained or injured.

  2. Neck trauma – Injury from whiplash or accidents may cause swelling or tearing.

  3. Post-surgical or post-radiation changes – Muscle scarring or atrophy may be described in follow-up scans.

  4. Incidental findings – Sometimes radiologists simply note their normal appearance to show they reviewed the entire region.

Suboccipital Muscles and Headaches

One of the most common reasons radiologists pay attention to these muscles is because of headache syndromes. The suboccipital region houses nerves that can become irritated when these muscles tighten or become inflamed.

MRI may show:

  • Mild swelling of the muscles.

  • Signs of chronic muscle strain.

  • Fatty replacement due to long-term disuse.

This information helps neurologists and pain specialists decide whether targeted treatments such as nerve blocks or physical therapy could help.

Clinical Relevance in Imaging Reports

When a radiology report mentions suboccipital muscles, the key points for patients are:

  • Normal finding: Most often, it simply means the radiologist looked at them and they appear normal.

  • Abnormal finding: If changes are seen, it usually relates to injury, chronic strain, or sometimes postoperative effects.

  • No cancer risk: These muscles are not a common site for tumors. If something unusual is found, the radiologist will specify clearly.

How Radiologists Distinguish Suboccipital Muscles from Other Structures

Radiologists use anatomical landmarks to identify suboccipital muscles:

  • The base of the skull (occiput).

  • The first two cervical vertebrae (C1 and C2).

  • The posterior arch of the atlas (C1) and the spinous process of C2.

These landmarks make it clear that the muscle group seen is indeed the suboccipital muscles and not deeper spinal muscles.

When Patients Should Be Concerned

Most mentions of suboccipital muscles are not alarming. However, you should discuss the report with your doctor if:

  • You have persistent headaches that are not improving.

  • You recently experienced trauma to the head or neck.

  • The report mentions swelling, edema, or asymmetry.

Your physician may recommend further tests, physical therapy, or referral to a pain specialist.

Personal Insight from Radiology Practice

As a radiologist, I often see suboccipital muscles on head and neck imaging. Most of the time, they look normal and are not the focus of the study. But in patients with chronic headaches, whiplash injuries, or neck strain, changes in these small muscles can be significant.

Conclusion

The suboccipital muscles are small but important structures seen on head and neck imaging. On radiology reports, their mention usually means the radiologist carefully reviewed the region. In some cases, changes in these muscles may explain headache, pain, or trauma-related symptoms. Most findings are benign, but discussing them with your doctor can help ensure you get the right treatment.

References

https://radiopaedia.org/articles/suboccipital-muscle-group?lang=us

https://www.ncbi.nlm.nih.gov/books/NBK567762/

https://www.abmp.com/massage-and-bodywork-magazine/suboccipitals-small-muscles-big-impact

Disclaimer: The content of this website is provided for general informational purposes only and is not intended as, nor should it be considered a substitute for, professional medical advice. Do not use the information on this website for diagnosing or treating any medical or health condition. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.

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