07 / Post-concussion & TBI

Why Does the Base of My Skull Always Feel Tight? The Myodural Bridge Explained

Cranial Solutions2 July 20256 min read

Persistent base-of-skull tightness and suboccipital stiffness after a concussion are associated with strain on the Myodural Bridge Complex (MDBC). The deep suboccipital muscles at the top of the neck (RCPm, RCPM and OCI) are physically linked to the spinal dura mater by dense connective tissue bridges. During a head or neck impact, these muscles may tighten protectively and pull on the cervical spinal dura. This may create a mechanical "choke point" at the C1/C2 level, which is associated with reduced cerebrospinal fluid (CSF) flow and cervicogenic headaches.

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The Biomechanical Problem: The Bridge Between Neck Muscle and Brain Lining

People recovering from a concussion commonly describe an ongoing, knot-like tightness at the suboccipital ridge, where the top of the neck meets the base of the skull. Stretching, massage and heat packs often give only temporary relief, because the tightness may begin deep within the Myodural Bridge Complex (MDBC).

From Impact to Base-of-Skull Pressure

Step 1: Whiplash force or head impact.
Step 2: Protective tightening of the suboccipital muscles (RCPm, RCPM, OCI).
Step 3: Ongoing traction carried through the myodural bridge.
Step 4: Pull on the cervical spinal dura and a craniocervical choke point.
Step 5: Reduced CSF circulation, associated with base-of-skull pressure.

The MDBC is made up of direct anatomical connections:

Suboccipital muscles: the rectus capitis posterior minor (RCPm), rectus capitis posterior major (RCPM) and obliquus capitis inferior (OCI).
Connective tissue bands: dense collagen fibres running from these muscles through the spaces between the skull, C1 and C2.
Dural attachment: the fibres blend into the outer surface of the cervical spinal dura mater.

Normally, the MDBC stops the dural sac folding inward during head movement and helps move cerebrospinal fluid. When whiplash causes the suboccipital muscles to tighten, the MDBC may pull continuously on the dura, holding it under ongoing strain.

See how neck and cranial drivers are assessed on our Post-Concussion Symptoms & TBI page.

Comparison: Surface Neck Tension vs. Deep Myodural Strain

Anatomical level

Surface postural muscle strain: Trapezius and levator scapulae muscles.
Deep myodural bridge strain: Deep suboccipital muscles and the MDBC.

Dural connection

Surface postural muscle strain: No direct link to spinal membranes.
Deep myodural bridge strain: Direct anatomical connection with the cervical spinal dura.

Response to massage

Surface postural muscle strain: Relaxes quickly with surface massage.
Deep myodural bridge strain: May stay tight due to underlying dural pull.

Fluid flow impact

Surface postural muscle strain: Little effect on brain fluid.
Deep myodural bridge strain: May create a choke point that reduces CSF flow.

Neurological effect

Surface postural muscle strain: Localised muscle aching.
Deep myodural bridge strain: Associated with cervicogenic headaches and dizziness.

Feature	Surface postural muscle strain	Deep myodural bridge strain
Anatomical level	Trapezius and levator scapulae muscles.	Deep suboccipital muscles and the MDBC.
Dural connection	No direct link to spinal membranes.	Direct anatomical connection with the cervical spinal dura.
Response to massage	Relaxes quickly with surface massage.	May stay tight due to underlying dural pull.
Fluid flow impact	Little effect on brain fluid.	May create a choke point that reduces CSF flow.
Neurological effect	Localised muscle aching.	Associated with cervicogenic headaches and dizziness.

How Myodural Strain Is Associated With Post-Concussion Symptoms

Ongoing pull across the myodural bridge may set off a series of nerve and fluid effects:

The Craniocervical Choke Point

Tightening of the MDBC may narrow the fluid space at C1 (atlas) and C2 (axis), reducing the flow of cerebrospinal fluid between the brain and spinal canal.

Headache Spreading From the Neck

The suboccipital muscles are rich in position-sensing muscle spindles. Ongoing tension may sensitise the upper neck nerves (C1-C3), which can refer pain over the top of the head to the forehead.

Unsteadiness and Dizziness

Abnormal tension across the MDBC may alter the position signals the neck sends to the brainstem, which is associated with an ongoing off-balance feeling.

Neck tightness, headaches or dizziness since a knock or whiplash? Read more on our Post-Concussion Symptoms & TBI page.

Supporting Movement and Fluid Dynamics

Easing myodural bridge strain involves an integrated structural approach:

Upper neck care: addressing atlas (C1) and axis (C2) alignment aims to reduce strain on the suboccipital muscle attachments.
Endonasal inflation (Nasal RX): controlled, brief inflations within key inner nasal passageways aim to ease sphenoid and cranial dural strain from above, helping the dural sac relax and reducing pull on the suboccipital bridge.
Supporting fluid flow: easing the craniocervical junction aims to support normal pulsing CSF circulation and daily fluid turnover. Individual results vary.

Frequently Asked Questions

What is the myodural bridge and why might my neck feel so tight?

The myodural bridge is a group of connective tissue bands linking the deep suboccipital muscles at the base of the skull to the dural membrane around the spinal cord. When a concussion causes these muscles to tighten, they may pull on that lining, which is associated with ongoing tightness. Learn more on our Post-Concussion Symptoms & TBI page.

Why doesn't regular neck massage ease my base-of-skull pressure?

Regular massage relaxes surface neck muscles like the trapezius. Base-of-skull pressure may begin deeper, in the myodural bridge, which connects to the dural lining of the spinal cord. If upper neck and dural strain remain, the deep muscles may stay tight. Read Why Am I Still Having Concussion Symptoms Months Later?

How might easing myodural tension help with brain fog?

The myodural bridge sits at a key fluid gateway between the brain and spinal cord. Easing tension here aims to support cerebrospinal fluid circulation and the clearance of inflammatory waste associated with brain fog. Read Why Do I Have Brain Fog and Fatigue After a Concussion?

For the full overview, visit our Post-Concussion Symptoms & TBI page.

Read Why Am I Still Having Concussion Symptoms Months Later?

Also see Why Do I Have Brain Fog and Fatigue After a Concussion?

Neck tension often accompanies Migraines & Headaches.

Learn about our clinical approach.

Browse the published studies on our Research page.

References

01Dura Mater & Migraines Synthesis Report (2025). Biomechanical stiffness (28-86 MPa) and dural mechanics.
02StatPearls: Dura Mater Anatomy (2024). Anatomical layers and dural partitions. NCBI Bookshelf / NIH.
03Al-Khazali et al. (2022). Neck pain co-occurrence in concussion and migraine: a systematic review. Cephalalgia, 42(9): 910-921.
04Zheng N, Chung BS, Li YL, et al. (2023). The relationship between myodural bridge, suboccipital musculature, and cerebrospinal fluid dynamics. Scientific Reports, 13: 18882.
05Frontiers in Medicine Review (2026). The myodural bridge complex: a comprehensive review of morphology, physiology, and pathology. Frontiers in Medicine, 13: 1790220.

Learn how our non-surgical endonasal protocol is used to evaluate suitability for conservative management, and how cranial base structural mechanics guide an individual care plan.