National Physical Therapy Examination (NPTE) Practice Exam

Which nerve is most likely involved in a patient experiencing cervical muscle tightness and headaches at the back of the head?

1. Trigeminal

2. Spinal accessory

3. Hypoglossal

4. Lesser occipital

The correct answer is: Lesser occipital

The involvement of the lesser occipital nerve is particularly relevant in cases of cervical muscle tightness and headaches localized to the back of the head. The lesser occipital nerve primarily provides sensory innervation to the skin overlying the posterior scalp and is associated with areas that may be affected in tension-type headaches and muscle tightness in the cervical region. When tightness manifests in the cervical muscles, this can often lead to irritation or entrapment of nearby nerves, including the lesser occipital nerve. The resultant symptomatology—such as headaches at the back of the head—can be traced back to disrupted sensations carried by this nerve, making it a likely candidate for involvement in this clinical presentation. Other nerves listed serve different functions that are less directly connected to the symptoms described. For example, the trigeminal nerve primarily innervates the face and often relates to issues such as facial pain or migraines rather than muscle tightness in the cervical region. The spinal accessory nerve is associated with motor control of the sternocleidomastoid and trapezius muscles, which may not directly cause the headache symptoms stated. The hypoglossal nerve primarily functions in the innervation of tongue muscles, having little relevance to headaches or muscle tightness