Atlanto occipital Joint

The atlanto occipital C1-C0 joint showing the ligaments.

Atlanto occipital joint is a common cause of headache which chiropractors treat.

This page was updated by Dr Barrie Lewis on 31st October, 2018.

It's the uppermost joint in the neck.

The bone that makes up the base of the skull is called the Occiput. If you place your hand on the back of your neck, and slide it up, those first boney protuberances you feel are the occiput.

The first bone in the neck is called the Atlas. It's really just a ring.

So the joint between them of course is called the Atlanto Occipital joint. It's where the nodding action of the head occurs.

Structurally, it requires some very demanding engineering features. It has to be extremely strongly bonded, or else the head would fall off the neck the first time a person experienced some trauma. Not good. This is achieved with very powerful stiff ligaments, and equally strong but flexible muscles.

Here you can see it on an x-ray. Fearfully and wonderfully made.

The spinal cord passes through a hole in the base of the occiput, called the Foramen Magnum, and down through the large hole in the Atlas. This is a cross sectional view, as seen from below, looking up at the skull, through the overlying atlas and Foramen Magnum. All sorts of interesting structures have to pass through that hole.

For example, two very important arteries wind their way up inside the spine, and make their way through the Foramen Magnum too.

They supply the posterior part of the brain and the balance organs in the inner ear.

The atlas bone.
The C0-C1 joint on x-ray
The occiput revealing the foramen magnum with the atlas superimposed.
The vertebral artery wending its way around the atlanto occipital joint.

Headache chiropractic

Strongly bonded but this region must also be fully movable, so it has to have a joint. Two, in fact. The joint surfaces of the atlanto occipital joint is covered with very hard hyaline cartilage that fortunately doesn't usually become arthritic. But they can become jammed up, or fixated as we call it. Then the neck becomes very stiff, and it's time for headache chiropractic to be considered.

The sensory nucleus of the largest cranial nerve, the Trigeminal, which supplies the jaw joint, sinuses, teeth, gums and face lies in this upper part of the neck.

Consequently, oddly, jaw joint pain, sinus pain... is often felt in the upper neck either as well as said jaw joint pain, or instead of it. This is very confusing sometimes for both the clinician and patient. Is this atlanto occipital joint pain, or is it referred from the TMJ anatomy? Or, both? I now routinely do a quick assessment of every patient with upper cervical pain.

If you have upper neck pain, and a popping jaw, pain in front of the ear or facial pain it is imperative that you tell your chiropractor. The problem may not lie primarily in your neck at all.

This jaw joint can also cause blinding migraine headaches and very severe facial pain.

Facet joints

Upper cervical facet joints

In due course, I'll add a page on the muscles of the region. They too are vitally important in the management of

Symptoms of whiplash

For those who survive a car accident there are a myriad of symptoms of whiplash from very severe symptoms (paralysis) to quite minor irritation (occasional headaches). Others include lack of concentration and dizziness; all potentially come from an injury to the atlanto occipital joint. Read more: SYMPTOMS OF WHIPLASH ...


Prolonged flexion of the occiput on the atlas, the nodding action, as in reading a book on a flat desk, places the suboccipital muscles under ongoing stretch. Devices such as this simple mobile desk are a must for every student, teacher, accountant ... in my view no home should be without at least one.

At a cost, delivered, of about three chiropractic consultations, it will pay for itself with weeks. 

Think too of a light correctly situated just above and behind your head for reading.

Posturite being used by Jean for a happy atlanto occipital joint.

If you spend long hours at the computer then intermittent ergonomic exercises are vital if you want less upper cervical joint pain, and general backpain and arm pain ..


Vertigo and the atlanto occipital joint.

Vertigo is a nasty condition that gives one the feeling that the world is spinning. It can be mild, a sudden feeling of dizziness when the head turned that last a few seconds only, but it can be very serious causing one to vomit repeatedly.

A chiropractic adjustment of the atlanto occipital joint is definitely not the treatment of choice.

During an attack one has the distinct sense that your eyes are spinning, even if you close your eyes. And so they are. The careful observer will note that the eye are moving in a specific fashion depending on which canal is affected; it's called nystagmus and lasts from a few seconds to a minute or more.

The most common cause is debris forming in one of the canals in the inner ear causing a condition known as benign positional paroxysmal vertigo. The good news is that bppv responds very quickly to a series of careful movements of the head called the Epley maneuver a course for your chiropractor.

How long does vertigo last? If the cause is bppv, and it's estimated to be 70% of cases of vertigo, then usually not long, often ceasing with a few minutes after the Epleys are done. But an infection in the inner ear, or Meniere's syndrome can cause the vertigo to last much longer.

Another cause is a subluxation of the occiput bone, and a gentle chiropractic adjustment is the treatment of choice. However, it should not be done until BPPV has been ruled out using a test known as the Hallpike Dix test or if you are showing signs of an upper respiratory tract infection. In these cases a Chiropractic adjustment can make the vertigo worse. It's generally agreed that medicines, other than antibiotics if you have an infection, have little or no place in the treatment of vertigo dizziness ... In fact, the side effects of stugeron, the medicine most often prescribed, are nausea and vomiting, the very symptoms you are trying to reduce.

Epley maneuvers mimic the chiropractic adjustment of the atlanto occipital joint.

The Epleys should only be done by a person trained in their use. Ask your chiropractor if s/he has done a course on the Epleys if you are suffering from vertigo. They should be done BEFORE the atlanto occipital joint is adjusted (and NOT on the same day).


Henry Gray was a truly gifted man. A qualified medical doctor, Gray was also an exceptional artist. He was the first to make a text book that would become the standard text for medical students for generations. Read more about this remarkable man; his sketches of the atlanto occipital joint were just one sign of his genius.

Chiropractic help

The long and the short of it is that upper cervical pain is an area that chiropractors have helped since DD Palmer gave his first adjustment, more than a hundred years ago. In fact, the bone setters of Europe and Asia were manipulating the atlanto occipital joint long before that too.

But it is a very sensitive area, hence the awful symptoms caused by a subluxation, and not a joint that is manipulated lightly and without considerable aforethought. Just yesterday I decided to deny an elderly patient the treatment of choice, a chiropractic adjustment, using an activator instrument instead, because I considered the risks significant. If she doesn't respond to the activator, I may well adjust her in the future, but try the conservative treatment first.

Chiropractic help is indeed one of the causes of iatrogenic disease, doctor-caused illness, but serious repercussions are very rare; but they do occur. Should every patient have his or her blood pressure taken before being given an atlanto occipital joint manipulation?

"Only a third of South Africans on hypertensive treatment have their condition controlled because they are not on the right drugs; people need two drugs, but which two varies according to their ethnic group."

- Professor Neil Poulter, president International Society of Hypertension


An inappropriate bedside light is one cause of atlanto occipital joint pain.

A traditional bedside lamp causing you to crane your cervical spine in order to gain sufficient direct light is a common cause of neck pain; think about the placement of your bedside lights.


  1. Head neck pain
  2. Atlanto occipital joint

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