Retrospective evaluation of CT-head scans for the association between posterior atlanto-occipital membrane ossification with  cervicogenic headache and migraine

Abstract Purpose- The objective of the study was to find the prevalence of arcuate foramen and its association with cervicogenic headache and migraine. To study various demographic parameters associated with the anomaly and to correlate the extent of ossification of posterior atlanto-occipital membrane with the severity of symptoms. Methods- A cross sectional study was done to analyze CT-head scans of patients with cervicogenic headache and migraine for the presence of arcuate foramen. Demographic parameters of the patients were collected from the detailed case report from achieves. The collected data was analyzed using SPSS, a p-value of <0.05 were considered significant. Results- Arcuate foramen was prevalent in 41.8% of symptomatic patients. No significant association between the incidence of arcuate foramen and age group was found. Incidence is increased incidence among the male patients (61%). Patients who are labourer by occupation showed increased incidence (34.78%). A positive correlation (0.755) was found between the extent of ossification and the severity of clinical symptoms. The foramen was more commonly found on the left side and majority of patients presented with unilateral anomaly (27.27%). Conclusion- Arcuate foramen is fairly prevalent among the symptomatic patients and is often neglected as an etiologic agent and leads delay in diagnosis and management. It can lead to injury to vertebral artery during screw placement if misidentified as broad posterior arch. Therefore, it must be screened in symptomatic patients and those patients undergoing lateral neck surgery using lateral cephalogram, if detected must be documented on health records of the patient.