Prevalence and characteristics of ponticulus posticus and its association with cervicogenic headache and migraine

Abstract

Background: Ponticulus posticus (PP) (arcuate foramen) is an abnormal bony bridge in the posterior arch of the atlas, which could possibly cause certain complications such as headache. Our goal was to assess the prevalence and size of PP on lateral cephalometric radiographs and its relationships with cervicogenic headache and migraine. Materials and Methods: This cross-sectional study was a descriptive–analytical type and was performed in Isfahan Azad Dental University. Lateral cephalometric radiographs of 150 patients referred to the radiology department were selected to assess the prevalence and size of the anomaly. A checklist was prepared to evaluate cervicogenic headache and migraine among patients. Results: Our sample consisted of 97 females and 53 males with an age range between 5 and 56 years. The prevalence of PP was 21.3% (12% complete and 9.3% incomplete), and an insignificant difference was noted between the prevalence of complete and incomplete foramen ( P > 0.05). The prevalence of foramen was higher in women (59.4%), but it was not significant. The mean width of complete foramen was 6.40 mm, and the mean heights in individuals with complete and incomplete foramen were 4.71 and 4.84 mm, respectively. Among patients with the anomaly, 43.8% had cervicogenic headache and 9.4% had migraine. There was a significant association between the presence of foramen and both types of headaches ( P < 0.05). However, there was no significant correlation between the shape of anomaly and the presence of cervicogenic headache and migraine ( P > 0.05). Conclusion: Our study showed a high prevalence of PP and its significant association with cervicogenic headache and migraine.

Frecuencia de Ponticulus posticus en Telerradiografías Laterales de Cráneo

“…Al igual que otros estudios, la presencia de PP se puede dar en cualquier edad, no existiendo diferencia estadísticamente significativa entre los grupos (Adisen & Misirlioglu, 2017;Gutiérrez et al, 2022). Frente a pacientes de diferentes edades que presenten dolor de cabeza de origen cervical, tensional y/o migraña, se debe considerar la presencia de PP ya que la presencia de PP se puede asociar a estos síntomas (Mokhtari et al, 2022;Najmuddin, 2022).…”

“…Dentro de los síntomas más comunes se incluyen: trastornos visuales, problemas con el habla y deglución, problemas vasculares, dolor de hombro, vértigo, síntomas de insuficiencia vertebrobasilar y dolores de cabeza (Geist et al, 2014;Lo Giudice et al, 2018). Se ha descrito en innumerables estudios la relación positiva entre la presencia de PP con migraña, dolor de cabeza de origen cervical y dolor orofacial (Chitroda et al, 2013;Mokhtari et al, 2022;Macrì et al, 2023). Esto se podría explicar debido a la compresión isquémica que se produce a nivel de la arteria vertebral o a la tensión que produce la duramadre sobre la membrana atlanto-occipital (Wight et al, 1999).…”

Prevalence of Ponticulus Posticus and Migraine in 220 Orthodontic Patients: A Cross-Sectional Study

“…Mokhtari et al [ 25 ]. found migraine in only 3.4% of patients without PP anomaly and a significant association between PP and migraine.…”

Frequency of Ponticulus Posticus in Cone-Beam Computed Tomography

“…In addition to the above, the PP is attached to the atlanto-occipital membrane, which is connected to the dura mater, temporarily causing tension during head movements on the meninge, triggering headache (3,4,26). There are countless studies that report the association between the presence of PP with migraine, neck pain and headaches (7,13,14,17). It is proposed that through surgical procedures such as fracture of the PP, blood circulation could be normalized, causing a reduction in symptoms (3,18,21).…”