Neck Pain Due to Jugular Vein Compression

Hi All,

I have had a few consults with Dr. Constantino and he is pretty convinced from my recent CTV that the jugular vein compression in my neck is rather severe. I am going to be seeing Dr. Hepworth in April for a consult and will make a decision on who to go with after that My main question is if I have compression between the C1 and the styloid would it be normal or make sense that I’m feeling neck pain from that?

From your posted image it looks like C1 is main culprit causing JV compression to me but you are lucky seeing best US medics on this topic. Good luck. D


Not sure about the source of pain, but your neck looks like stuck in permanent chin-tuck position. You might want to check if your posture and whole spine curvature is correct, also if you don’t have anterior pelvic tilt, aka butt sticking out.

Ah, I’d absolutely avoid any chiro manipulation on the neck. And I’d check with someone who knows about CXA (clivoaxial angle) as you might have it too small, which might be either congenital, acquired, or just postural.


So that is a good question. I have a military neck with some moderate CCI and I’m wondering if I’m able to do some posture work and bring the curve back to my neck, which could maybe relieve the symptoms as opposed to C1 shaving, but maybe I’d need both.


If you have low-angle CXA (x-ray with extension/neutral/flexion might help, or just use the relevant CT scan image), the proper posture of the upper cervical spine might be all you need. You have a good flow of jugular in general, just that it is pinched at the C1 level, I’d guess, exactly because your C0-C1 is “stuck” in the position of being permanently “looking down”.
Chiro manipulations might make it even worse.

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@vdm what in the images gives away this permanent ‘chin tuck’. ?


So, keep in mind I am laying down for the CTV scan so that may be why it seems like that.


@LimeZest I don’t even know how to explain it…

Somehow after seeing lots of various x-rays, CT scans, I sometimes try to imagine what the bare bones would look like, and what “posture” might cause it.

Now that you asked, I opened one of the CT scan cases (let’s call the person in that case “R”)

(Ignore the title that it’s “normal”)

Even though R has straightened neck on the scan, a bit longish styloid processes, severe compression of IJVs between the SP and C1 TP (again, in the scan), still the facial features, skull bones etc. look as if they were giving higher CXA in R’s case than in Paul’s. It feels that Paul’s C0-C1 joint is more in flexion than the R’s, and the place where the neck meets thoracic spine is less articulated, more linear shape.

Obviously, I might be totally wrong.

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I can see the difference, @vdm & agree w/ you about @pauld1635’s image showing a more “tucked” chin position. My first thought when I saw the image, before I read the posts, was, “This guy has military neck” (as opposed to forward head posture).