Twelve patients were treated over a 3-year period for jugular BHS (10 women, 2 men, age at presentation 46.3+/- 13.2 years, median= 44 (31-74) years, duration of symptoms before presentation= 4.6+/-5.6 years, median 1.75 (0.083-15) years). Five had concurrent jugular vein compression at C1 (Eagle’s syndrome), 10 had concurrent thoracic outlet syndrome, and 5 had concurrent pectoralis minor syndrome. Venography showed compression of the IJV under the SCM induced by head turning with massive retrograde flow to the skull base including the petrosal sinuses that drain the inner ear. Venous shunting occurred down the vertebral veins that drain the cervical spinal cord. Seven patients underwent bilateral SCM partial myotomies; one unilateral decompression. Four patients were treated with bilateral SCM and anterior scalene Botox without surgery. 11 patients experienced resolution or >70% improvement in head motion-triggered vertigo. One patient reobstructed and had no improvement. Other improved symptoms included syncope, headache, pulsatile tinnitus, neck pain, and limb paresthesias.

SCM entrapment of the IJV causing a "jugular BHS," represents a significant and more common mechanism for head rotation-induced vertigo compared to arterial BHS while also accounting for a wider variety of symptoms such as headache, tinnitus, paresthesias, and myofascial pain. Symptoms can be managed with PT, Botox, or surgery.