Basilar invagination in headache associated with physical exertion and recurrent torticollis.

A 52-year-old man presented with a 2-year-history of recurrent torticollis and headache associated with physical exertion (including evacuation). His physical examination disclosed short neck and brachycephaly. Neuroimaging studies (Figures 1 and 2) revealed basilar invagination and brainstem compression without other craniocervical junction abnormalities or systemic diseases. Basilar invagination must be included in the differential diagnosis of exercise-induced headache with recurrent torticollis, especially if pyramidal signs, ataxia or other cranio-vertebral anomalies in the neuraxis are present.