OBJECTIVE Muscles supplied by the spinal accessory nerve are particularly prone to the development of trigger points characteristic of myofascial pain. This study aimed to confirm sensory pathways in the spinal accessory nerve and to describe sensory ganglion cell distributions along the lower cranial nerve roots. METHODS Using sagittal sections of ten human embryos at 6-7 weeks and horizontal sections of three 15- to 16-week-old embryos, we analyzed ganglion cell distributions along the lower cranial nerve roots, including the spinal accessory (XI) nerve. RESULTS In all ten 6- to 7-week-old embryos, the XI nerve root contained abundant ganglion cells, which were evenly distributed along the XI nerve root at levels between the jugular foramen and the dorsal root of the second cervical nerve. However, the hypoglossal (XII) nerve roots did not contain ganglion cells and did not communicate with nearby roots in the dural space. Thus, the so-called Froriep's occipital ganglion is unlikely to be associated with the XII nerve but rather with the XI nerve roots. According to observations of three larger fetuses (15-16 weeks), most of Froriep's ganglion cells seemed to have degenerated during early fetal life. CONCLUSIONS Nociceptive sensory pathways in the adult human XI nerve may be much more limited in number than would be expected based on previous animal studies. However, it is possible that sensory ganglion cells in the embryonic XI nerve root send axons toward the developing spinal accessory nerve fibers outside of the jugular foramen.