Great Occipital-Trigeminus Syndrome as Revealed by Induction of Block

THIS TRIPARTITE syndrome presents symptoms (1) confined to the distribution of the great occipital nerve, (2) shared by the trigeminus, or (3) shown by the trigeminus alone, as a nociceptor to passive stimulation by the vulnerable great occipital nerve. In every case alcohol block (Fig. 1) relieved all symptoms. Pinprick verification of numbness was made in all cases; it presaged relief lasting 6 to 12 months, permanent relief being more frequent than recurrence. At times the needle piercing the great occipital nerve produced pain radiating to the homolateral supraorbital notch (Fig. 1; Table 3). Most of the items in Table 3, together with relief of all symptoms on block of the great occipital nerve, suggest a functioning contact between the great occipital nerve and the trigeminus. According to Ramon y Cajal,* only those fibers derived from the ophthalmic division of the trigeminus reach the lowest level (C 2) of the