External Carotid in Contact with Styloid Question

I’m new to the forum, from Canada, and here with a question. I’ve been bouncing from doctor to doctor for over a decade now and have had lots of imaging done along the way. The only diagnosis thus far is migraines and anxiety. I’ve always felt my anxiety was a natural response to something seriously wrong and not a disorder. I’ve always felt my migraines are “secondary” and have asked a lot of questions pointing to various items on MRIs and CTs. The responses are usually “normal variant” or “incidentally finding” and “quit googling”.

I just noticed that my styloids are touching my External Carotid Arteries. I cannot find any information that suggest this is a “normal variant”. By my measurement, my styloids are 3.3 cm.

My question: The imaging shows my ECAs to be in contact with the styloids. Is this a radiological finding that is undeniable proof of a pathological issue? Or is there a certain percentage of the population that have styloids making contact with ECAs that are asymptomatic and thus this could be argued to be an “incidental finding” or “normal variant”? My radiology reports do not mention the styloids.
I’m tired of arguing with doctors and would simply like to have concrete evidence there is something causing my symptoms.
I also suspect Jugular compression as my styloid to C1 transverse process is 3.5mm for a rather large jugular. But if I’m understanding everything correctly, this is a contentious issue, correct?

Thanks for any insight

My (unprofessional) opinion - the carotids look fine in the slices you’ve shown. Both of my external carotids contact the styloids for about a centimeter. I think it’s only a problem when the vessels are trapped between the styloid and a vertebra. Based on the normal anatomy, this is only likely to happen for the internal carotid. On the other hand, I think you have quite clear bilateral jugular compression that looks significant enough to cause symptoms. I see the scan was taken for tinnitus, which is one of the most common symptoms for jugular compression. If you have your MRI handy, have a look for signs of elevated intracranial pressure like empty sella or tortuous optic nerve sheaths.

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In rare cases, the external carotids can be in contact w/ the styloids but much more often, it’s the internal carotids. As @coldbear mentioned, typically it’s the internal carotids that cause trouble due to the internal neck anatomy set up. I agree that your IJVs look compressed, one more than the other. That is what could be causing your headaches & is likely more where your focus should be.

There have been some very in depth discussions about IJV compression, blood flow, proper testing, etc.,(use the magnifying glass icon search tool & type in IJV compression to get started) along w/ posting of links to research articles about these (see Research Article link under the General category on the home page). @KoolDude & @vdm have both posted a lot of helpful info along w/ others on this forum.

Thanks for the responses. Yes, I agree the jugular seems stenosed and I have a heap of symptoms that correlate. But it seems jugular stenosis is difficult to diagnosis and not readily recognized (my sella is normal as is my optic nerves). I was just hoping for something indisputable.
At any rate I reached out to an American doctor. The staff I spoke with didn’t need any convincing, and she is arranging an appointment. Such a breath of fresh air to be taken seriously.

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For the sake of comparison, here is a scan where you can see both externals in contact with styloids, as well as a comparable degreee of jugular compression. Collateral veins are pretty prominent here - do you see them in yours? Unfortunately eagle diagnoses are rarely indisputable, but collaterals at least suggest the main pathways are insufficient.


Thanks for the comparison coldbear. The collaterals on my right side are “slow to fill” which doesn’t support a diagnosis of jugular compression, in my unprofessional opinion… However I have noticed at the point of connection to the “anterior condylar??” to be very narrow in comparison to my left side. So perhaps my condylars/collaterals would be taking on more flow but a narrow connection isn’t allowing for it? I also wonder if a dilated jugular could impinge the condylar itself?

Who knows haha…those questions are definitely beyond the scope of what a single scan showing one position/moment in time can answer. There are so many other paths venous blood can take. I believe my occipital head pain might be caused by increased flow through occipital emissary veins irritating nearby nerves. I was lucky enough to get scans with my neck neutral and flexed (which provokes symptoms) positions, and my jugulars go from about 75% compressed in neutral to 90+% flexed. Do you notice any positions or actions that provoke symptoms for you? For me, it’s neck flexion and leftward rotation, salty foods, dehydration, or even a little caffeine.

On the bright side, it looks to me like your jugular compression is clearly caused by styloid impingement (rather than some C1-foramen misalignment), so it should be an easy fix for an experienced eagle doc.


@coldbear Not sure the significance of this but in addition of the ECA & Styloid contacts, there appears to be contact between the left Hyoid Bone and left ECA ( Blue Arrow → Hyoid Horn, Red Arrow → ECA). This study ( Styloid and Hyoid Bone Proximity Is a Risk Factor for Cervical Carotid Artery Dissection) found that ICA & Hyoid and ICA & Styloid close proximity has an increased risk factor for Carotid dissection. So since this is touching ECA, not sure if it warrants additional investigation with Dynamic CT.

Also I see what appears to be a bit of displacement on your right Thyroid Superior Cornu anteriorly ( I could be wrong but very close to the throat), Not sure if it is causing any symptoms. This is usually linked to foreign-body sensations in the throat or throat issues as the case here (https://journals.sagepub.com/doi/pdf/10.1177/014556131109000612 & An Unusual Cause of Foreign-Body Sensation in the Throat: A Displaced Superior Cornu of the Thyroid Cartilage | Semantic Scholar).