Cervical osteochondrosis often affects the artery

Why does headache affect cervical osteochondrosis?

Headaches for cervical osteochondrosis - the same constant symptom as cervical pain( cervicalgia), a violation of sensitivity and volume of movements in the upper limbs and in the shoulder girdle. Moreover, because of this sign, cervical osteochondrosis is sometimes confused with a cerebral stroke. Hence the wrong treatment. Although the individual moments of pathogenesis in these two diseases are similar. And even some medicines can be used in either case. Nevertheless, these are two fundamentally different pathologies.

Reasons for

What causes a headache with cervical osteochondrosis? To answer this question, let us touch upon the questions of anatomy. Blood supply to the brain is carried out by two systems. Most of the blood in the brain comes through the system of carotid arteries. The narrowing of the lumen of the middle cerebral arteries, which are branches of the carotid arteries, leads to a cerebral stroke. Fortunately, the carotid arteries and their branches with cervical osteochondrosis are not affected.

The smallest part of the blood enters the brain through the system of vertebral arteries. These arteries approach the brain through special openings located in the transverse processes of the cervical vertebrae. In cervical osteochondrosis due to metabolic disorders, the intervertebral discs lose their strength and elasticity. Therefore, they are easily displaced when the head and neck move, as a result of physical influences. Together with the discs, vertebrae that have lost their cartilaginous lining can also be displaced.

There is a so-called.subluxation of cervical vertebrae. As a result of displacement of the intervertebral disc with the presence of subluxation, not only the vertebral artery, but also the nerves of the cervical plexus, is impaired. Thus, two components, vascular and nervous, are involved in the fact that the head is aching with osteochondrosis. In this case, the so-called.vertebral artery syndrome.

Symptoms of

Pain in the head is the leading, but by far not the only manifestation of the vertebral artery syndrome. In addition to the pain in this case are noted:

  • Nausea
  • Vomiting
  • Dizziness
  • Short-term loss of consciousness
  • Paresthesia in the nape, on the face, in the sky
  • Visual disorders( shroud, flashing before the eyes)
  • Feeling of ringing in the ears
  • Foreign body sensations in the throat
  • Decreased performance, general weakness, insomnia
  • Behavioral disorders - tearfulness, irritability.

By nature, the pain is bursting, pressing, spreading from the occiput to the crown. Painful sensations can be associated not only with the infringement of the vertebral artery. Often, such patients suffer from the very skin of the occiput. It should also be noted that pain, paresthesia, auditory and visual disorders are unilateral in nature, respectively, the affected artery. With a sharp turn or tilt of the head all these symptoms intensify. Also there is a giddiness. Sometimes the head turns so much that the patient can fall and get injured.

Vertigo from osteochondrosis is often combined with high blood pressure. Some mistakenly interpret these phenomena as signs of high intracranial pressure( ICP), caused by a violation of venous outflow. This is not entirely true. First, venous outflow with cervical osteochondrosis does not suffer. Otherwise, this disease would have been even worse. And to measure ICP is not so easy. To do this, you need to measure the pressure of cerebrospinal fluid or implant special sensors in the brain. Both are justified only in exceptional cases. A rise in blood pressure is most often due to autonomic disorders, which are unavoidable in cervical osteochondrosis.


An old well-proven remedy for headache with osteochondrosis - Analginum with Dimedrolum, Papaverinum or No-shpa. Yes, analgesics in combination with antispasmodics effectively eliminate the headache. But only for a while. In addition, these drugs do not affect those pathogenetic mechanisms that led to such painful sensations. Much more effective drugs from the group of neuroprotectors. This Actovegin, Piracetam, Thiocetam, Neuromidine, Mexidol. These agents improve metabolic processes in the brain, and thus eliminate pain and other negative manifestations of cervical osteochondrosis. True, take them should be a multi-day course.

More Articles: Exercises for the treatment of cervical osteochondrosis

It is possible to eliminate vegetative disorders and mental disorders( excitability, irritability of insomnia) with tranquilizers. This includes Sibazon, Seduxen, Relanium. True, recently these funds are equated to drugs, and therefore are under prohibition. They are released only on the prescription of a doctor, written on a special form. Herbal extracts of valerian, motherwort, and peony have a good sedative effect. All of the above medicines can and should be combined with taking vitamins. Although the vitamins themselves will not eliminate the headache. But with the help of ascorbic acid( Vit. C) and tocopherol acetate( VitE).can improve the supply of the brain with oxygen, and thereby at least partially interrupt the chain of negative processes in the central nervous system.

Treatment of headaches must include massage procedures. In this case, a so-called massage is performed.collar zone. This improves blood circulation in bone, muscle tissue, and in the brain. However, massage of the collar zone is contraindicated if the cervical osteochondrosis proceeds against a background of high blood pressure.

Cervical osteochondrosis and headaches are treated with a set of health-improving physical activities. Physical exercises strengthen the muscular cervical framework, and thus contribute to improving blood circulation through the vessels of the neck. However, the complex of exercises in this case should be selected with special care. No rotational movements, sharp inclinations and tilting of the head! At the heart of exercise therapy in this case are static loads - the emphasis of the frontal or temporal region on the palm applied with resistance, the slow reduction of the head to the trunk. In any case, health gymnastics is carried out only after the medicinal relief of headache exacerbation.

Phonophoresis, amplipulse, electrosleep are shown among physiotherapeutic procedures. Very good acupuncture, acupuncture, or acupuncture. And the simplest kind of acupuncture is available to everyone. This is a well-known applicator Kuznetsova. Enough for 15 minutes.put this needle massager under your neck so that the pain in your head decreases, or you leave completely. Recently, a qualitatively new method for treating osteochondrosis and its manifestations-osteopathy, has appeared. It does not directly remove the pain in the head. But with the help of special techniques and manipulations, the osteopathic physician removes structural and functional disorders in the cervical region. At the same time many manifestations of cervical osteochondrosis are suppressed, incl.and a headache.


Causes, manifestations and treatment of vertebral artery syndrome

Pulsating pain in the head, periodic sensation of dizziness, extraneous tinnitus may indicate the onset of vertebral artery syndrome.

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The disease needs timely treatment, since in advanced cases it can become the main cause of ischemic stroke.

What is vertebral artery syndrome

Vertebral arteries are only two, they start from the subclavian artery and are involved in the blood supply to the brain.

Syndrome of the vertebral artery is usually designated as a whole complex of various disorders in the body that arise from pressure on the artery and the plexus of nerves around it. Changes can affect both one of the vertebral arteries, and both simultaneously.

Deterioration of the blood supply to important parts in the brain leads to pathological changes in their functioning and, ultimately, to ischemic processes and stroke.

Causes of

There arises a syndrome of vertebral arteries in humans under the influence of two main groups of causes. These are:

  • Not vertebrogenic, that is not related to the pathologies of the vertebral column itself. These reasons include congenital anomalies of the development of one or two vertebral arteries at once, this can cause their excessive tortuosity, the diminution in diameter. Also, no vertebrogenic causes are associated with atherosclerosis.
  • Vertebrogenic causes include diseases affecting the spine. These are traumas, tumors, in adults Bekhterev's disease. But nevertheless, in the first place among the causes of the development of the syndrome of vertebral arteries, a person has cervical osteochondrosis.

Symptoms and signs of syndrome in cervical osteochondrosis

The main culprits of the vertebral artery syndrome in cervical osteochondrosis are:

  • Osteophytes, that is, the growth of bone protrusions on the vertebrae. This leads to mechanical compression of a number of located vessels and mainly the vertebral artery. Osteophytes also constantly irritate the surrounding nerve plexus surrounding the vessel, which further increases the spasm of the artery.
  • Deviation of the vertebrae from their normal location.
  • Inflammatory processes in the tissues of the neck. Inflammation causes swelling, it puts pressure on the vessel.
  • Muscular spasm in the cervical region. Spasmodic muscle in osteochondrosis of the cervical region is due to reflex protection of the body in response to pain and restraint.

Insufficiency of blood flow to the brain always leads to the development of characteristic symptoms, with the syndrome of the vertebral artery, patients most often complain about:

  • Severe headache. It can be in the form of a pulse, constant, localized in the nape of the neck and crown, above the eyebrows, often marked only on one side. The pain intensifies after sharp movements of the neck or after a dream with an inadvertently or awkwardly turned head.
  • Dizziness, tinnitus.
  • Periodic nausea and vomiting without relief.
  • Violations of visual function - the appearance of flies, shroud and double vision. Perhaps the fall of visual acuity.
  • Hearing loss, most often this sign is fixed on one side.
  • Violations in the coordination of movements.

If a person also has a history of heart disease or hypertension, then, in squeezing the vertebral artery, in addition to the main signs, you may be bothered by pinching or stitching pains in the heart area.

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A smaller proportion of patients with Bernard-Horner syndrome, manifested by burning and tingling in one side of the face, sensation of a foreign object in the throat.

Clinical development of the disease

Clinical manifestations of the disease depend on the degree of pathological hemodynamic disturbances and on the type of disruption of blood supply to the brain regions. It is accepted to classify the vertebral artery syndrome according to the degree of revealed hemodynamic changes in two stages:

  • Functional , it is also denoted by the term dystonic, the stage is manifested with an almost constant headache. Increases pain with sharp turns of the head and neck, after finding a long time in one position. By nature, the pain is pulsating, burning, aching, it covers mainly the back of the head, whiskey, forehead area. At the same stage, the sick person often complains of dizziness, it can be manifested by a feeling of instability, a feeling of rapid rotation by nearby objects or a feeling of falling of one's own body. In addition to dizziness and pain in the dystonic stage, often disturbed by hearing disorders, visual function.
  • Ischemic ( another name organic) the stage is manifested by transient ischemic attacks. These are sudden attacks of severe dizziness, pronounced disturbances in coordination of movements, speech changes, nausea and vomiting. Ischemic attacks often occur precisely with sudden changes in the position of the head, and if a person can take a horizontal position, then regression, that is, stabilization of well-being, is possible. After the attack, for a while, lethargy, weakness, sparks in the eyes, tinnitus, headache may be disturbing.

By the nature of hemodynamic disorders, the disease is divided into:

  • Irritative form. This variant of the syndrome is formed as a result of irritation of the efferent sympathetic fibers, which causes a spasm of the arteries.
  • The angiospastic form of arises as a result of reflex spasm upon irritation of the receptors. As symptoms of this form, diffuse vegetative disorders predominate, not associated with various head movements.
  • Compression form occurs when mechanical compression of the vessels caused by the pathology of the cervical region.

Diagnosis and treatment

Assume that the patient has a syndrome of the vertebral artery, a neurologist or a therapist may be symptomatic of the disease.

A number of instrumental examinations are assigned to confirm the diagnosis:

  • USDG - ultrasound dopplerography. This examination reminds on the carrying out of US and allows to reveal the sizes of vessels, speed of a current of a blood in them, presence of gorts and narrowings.
  • MRI allows you to detect ischemic foci, the degree of blood supply to the brain.
  • Radiography is used to determine the cause of the disease.
Treatment begins immediately after confirmation of the vertebral artery syndrome, and it must necessarily be complex.

Drug therapy

Drug groups are selected based on all identified changes and symptoms that affect the patient.

In most cases, the following therapy regimen is prescribed:

  • Anti-inflammatory, it is aimed at relieving inflammation and pain, especially in cervical osteochondrosis. The course uses Nimesulid, Ibuprom, the dosage is selected individually.
  • Drugs for improving venous outflow. Assign Diosmin, Troxerutin, in hospital conditions intravenously drip L-lysine.
  • Improving the patency of the vertebral artery is achieved through the use of Trental, Agapurin.
  • Drugs that reduce hypoxia of the brain, this Mexidol, Actovegin.
  • Preparations that improve blood flow to the brain - Thiocetam, Pyracetam.
  • Neuroprotectors - Gliatillin, Solmazin.
  • With marked and frequent dizziness appointed Betaserk, Betagistin.
  • Course of vitamins.
  • When osteochondrosis is detected, chondroprotectors are prescribed.

Some of the medicines for the patient are prescribed for several months. The dosage of drugs is selected by the doctor specifically for each patient and therefore may vary.

Folk remedies

Folk methods of treatment of vertebral artery syndrome should be used only in combination with drug treatment, since this disease always requires a serious approach to its therapy. The most popular products include:

  • Garlic tincture. Three large heads of garlic need to be cleaned, chopped, poured into a jar and left in a cool place for three days. Then the resulting mass is filtered and to it in equal proportions is added natural honey and fresh juice from the lemon. Take this medication on a tablespoon before bedtime, it dilutes blood well and promotes better blood flow.
  • Coniferous baths. For their preparation, pine needles, cedar, fir, spruce will suit. The needles are brewed and poured into the water after 12 hours of infusion. This bathroom removes the spasm from the muscles, relaxes well and promotes better blood flow, take it for 20-30 minutes.
  • Dessert grass helps with dizziness. It is brewed from the calculation of a liter of boiling water for two tablespoons of herbs, it is necessary to brew for the night. Over the next day, the whole drink is consumed in four divided doses.

Treatment at home

The use of prescribed medications at home is often recommended in combination with the wearing of a special cervical corset, called the collar of Shants.

It is compulsory after the relief of acute symptoms of the disease at home to perform daily exercise programs. Lessons should be selected by the doctor taking into account all changes in the spine.

The simplest exercises that can be recommended for vertebral artery syndrome include:

  • Cautious head turns. The amplitude of movements should be increased gradually.
  • Slopes.
  • Performing tilts and turns with back pressure. That is necessary, turning his head to the side, hand to try to keep it from this movement.
  • Shrugging.

In a subacute period, a massage may be prescribed, but it should be performed by a highly qualified specialist in vertebral artery syndrome. Physiotherapeutic procedures are shown.

Is it possible to cure

Complete recovery of patients with vertebral artery syndrome depends on many factors.

This is the treatment of the disease, the use of effective drugs in full course, full home treatment. It is often possible to completely restore normal blood flow in the vertebral arteries only after the operation.


In cervical osteochondrosis, the development of the syndrome can be prevented by the continuous implementation of certain preventive measures for this complication. These measures include:

  • Daily exercise. Kneading during the day groups of neck muscles.
  • It is necessary to sleep on an orthopedic mattress and pillow.
  • Massage courses at least twice a year.
  • Full and timely treatment of osteochondrosis.

A vertebral artery syndrome can lead to very serious complications, some of which result in a disability.

Therefore, when the first signs of the disease appear, one must undergo a diagnosis and a course of effective treatment.

Video about vertebral artery syndrome:

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Dizziness in the osteochondrosis of the cervical spine( treatment, symptoms)

The duration of dizziness, according to the research of practicing specialists, can last from a few minutes to hours. It depends on the general condition of the patient and the main cause of the disease.

In case of fainting and pre-memory states, to avoid serious consequences of cerebral blood flow disorder - a person should be laid horizontally, with legs elevated and head lowered.

If you do not treat dizziness with osteochondrosis over time develops vegetative-vascular dystonia, other serious vascular pathologies.

Osteochondrosis and dizziness - how are they related?

Cervical vertebrae are much smaller in size than vertebrae in other departments. But, the load on them is very serious, connected with the retention of the head. This is why the cervical spine is often affected by osteochondrosis, and dizziness is often a concomitant symptom of the disease.

Spine site of the vertebral artery

Even a slight muscle strain or a slight displacement of the vertebrae provokes the infringement of the vessels, squeezing the nerve endings in the neck. This is the main reason why patients suffering from cervical osteochondrosis are dizzy. The organism is dizzy showing a reaction to squeezing the vertebral artery( stenosis).

Due to compression of the artery, blood circulation in the cerebellum and spinal cord is reduced: in some parts of the nervous system, oxygen starvation occurs, due to compression in the occipital often the brain, where the center responsible for the vestibular apparatus is not receiving blood.

One of the characteristic signs of the disease is a crunch that occurs when the head moves.

To whom to address at a dizziness from an osteochondrosis?

Be sure to consult a doctor at the first malaise!

Vertigo, as a rule, is engaged in a neurologist, but if you feel dizzy with osteochondrosis, it makes sense to seek help from a vertebroneurologist, a surgeon.

For more accurate diagnosis of the disease, try to describe in detail the symptoms: even the most insignificant part will help the specialist to specify the diagnosis.

To determine the disease and an accurate diagnosis, doctors prescribe the following types of diagnosis:

  • MRI - magnetic resonance imaging of vessels;
  • radiography.

Treatment of dizziness in cervical osteochondrosis: the basic methods of

Treatment, appointed by a survey specialist, can take place at home or in the hospital. As a rule, to cure dizziness in cervical osteochondrosis, doctors prescribe a comprehensive treatment: pharmacological agents, exercise therapy, massage, and others.

Complex treatment of vertigo in cervical osteochondrosis should not only relieve this unpleasant symptom, but also eliminate its causes. After all, only getting rid of the main cause of malaise - cervical osteochondrosis, the patient will be cured of dizziness.

Medical treatment

For the treatment of the disease, specialists are appointed:

  • analgesics - relieve pain;
  • non-steroidal anti-inflammatory drugs - remove inflammation and swelling in affected areas, as a result, there is a significant decrease in compression of nerve roots, arteries, blood supply is normal, brain nourishment, dizziness is not repeated;
  • vitamin complexes and B vitamins - improve metabolic processes;
  • vasodilator preparations that improve blood flow - affect locally, reduce the number, intensity of attacks of dizziness, but the cause itself is not treated, and therefore after the course of taking vasodilating medications, dizziness may resume.

Alternative medicine

To eliminate the main cause of dizziness - osteochondrosis not only uses medicines, physiotherapy methods are very effective.

Reflexotherapy( action on biologically active points of the body) and physiotherapy

Physiotherapeutic procedures relieve pain syndrome, normalize metabolic processes, eliminate inflammation.

  1. Exposure to the affected area with ultraviolet light contributes to the production of vitamin D, which promotes the absorption of calcium.
  2. Magnetic field - improves metabolic processes and circulation.
  3. Laser treatment of affected areas activates regenerative processes in the tissues of the nervous system.
  4. Low-frequency current contributes to increased blood circulation due to the heat produced.


Treatment of osteochondrosis and getting rid of dizziness is carried out with the help of massage. All movements are carried out cautiously, slowly, the occurrence of pain is not allowed. Professional massage of the muscles of the neck and shoulders - relieves muscle tension, restores blood circulation, facilitates the condition with pain syndrome.


Observing a special diet developed by a specialist, you can eliminate the symptoms of the disease and make the treatment of the disease as effective as possible. It is highly recommended that doctors remove sharp, roasted dishes from the menu, exclude alcohol, eat less coffee, do not smoke, eat less salt.


Effective remedy for dizziness in osteochondrosis - self-massage. The stretching of muscles removes from the spasm, releases blood vessels and jammed nerve endings.


An excellent therapeutic effect in the treatment of osteochondrosis is provided by phytotherapeutic drugs - medicinal herbs and their collections, which act as diuretics, which remove excess salts from the body. In the majority of herbal collections there are herbs of anti-inflammatory action that improve blood circulation, eliminate muscle spasms.

For maximum results, phytotherapeutic agents must be taken for a long time.

LFK and gymnastics

A lot of exercises for the cervical vertebrae have been developed, which will help to strengthen the muscles surrounding them and thereby relax the muscles of the neck. The main rule is the regularity of the exercises, but if the pain worsens and the general condition worsens, you need to see a doctor. Strengthening the muscles in this way, you can in the near future get rid of dizziness, attacks of headaches.

During the exacerbation of the disease, exercises to eliminate dizziness can not be performed - so you can provoke complications.


A well-known truth is: "It is better to prevent a disease than to treat it"!

Do not neglect preventive measures that can reduce the risk of dizziness:

  • withholding smoking and alcohol;
  • avoidance of physical overstrain;
  • sports and physical exercises, which are aimed at stretching the muscles.


Dizziness and osteochondrosis are connected with each other indissolubly. To get rid of this unpleasant phenomenon, it is necessary to observe the temperature regime and the regime of the day, strictly follow the diet. To improve blood circulation and nutrition of the brain, the violation of which leads to dizziness, there are many methods.

Contacting a doctor, he will appoint the most effective or their set of measures.


Syndrome of the vertebral artery with cervical osteochondrosis

Have you noticed that you have systematically, unreasonably started to worry about the pain in the neck, dizziness, nausea and tinnitus? It is possible that these are harbingers of the vertebral artery syndrome or cervical migraine, as it is customary to call a disease among medical workers. The syndrome is characterized by compression of the vertebral artery, which causes a violation of blood flow to the brain. If you do not start timely therapy, the syndrome is dangerous for a number of neurological disorders, up to the occurrence of an ischemic stroke. The latter is observed in more than thirty percent of patients, especially in the age group of forty.

Causes of vertebral artery syndrome

Vertebral artery Vertebrogenic - disorders associated with diseases of the spine. Most often caused by cervical osteochondrosis. With vertebrogenic disorders, vertebral artery syndrome develops, can even at a young age. For this reason, it is extremely important to conduct regular examination of the spine, starting from school age. Nonvertebrogenic - lesions not related to diseases of the spine, are caused by atherosclerosis or anomalies in the development of arteries. As a rule, by themselves they do not cause the development of the syndrome, only in combination with other causes, can create an unfavorable background. These include:
  • arterial pathology, such as thrombosis and embolism;
  • trauma and spasms of the neck muscles.

Stages of the development of the disease

Angiodystonic, the first level of the disease, the best period for a successful course of therapy, usually not requiring surgical intervention. All the unpleasant pain that accompanies the course of the disease will pass quickly enough with the right treatment. The second degree of disease progression is ischemic. At this stage, following the painful syndrome, irreversible consequences occur in the form of neurological disorders.

Symptoms of cervical migraine

  • Strong pulsating and burning headaches, pronounced in the occipital part, temples;
  • Noise and padding of the ears accompanied with hearing impairment;
  • Sharp changes in blood pressure;
  • Pain in the eyes and blurred vision;
  • Progression of osteochondrosis;
  • Dizziness accompanied with darkening in the eyes, nausea and vomiting;
  • Pressing pain in the chest with palpitations.
Artery compression. With the progression of the vertebral artery syndrome, ischemic attacks are observed, the conditions under which, coordination of movement, speech, swallowing can be disturbed. With the emergence of even a portion of these symptoms, you should immediately contact a neurologist. There are people who automatically are at risk. In whom there is an increased possibility of the manifestation of the vertebral artery syndrome. Patients who received a back injury, who had an accident with vertebral injury or suffering from hypertension.


Ultrasonic dopplerography, - the procedure is similar to conventional ultrasound. Allows you to determine the speed and patency of blood flow through the arteries. Detects abnormalities and difficulties in the work of arterial blood flow. Research, is fundamental for diagnosing. Radiography of the cervical department. The method helps identify changes in joints, including osteochondrosis. MRI of cervical vertebrae and brain. The first study will help to identify pathology in the vertebral column and intervertebral discs. The second, will determine ischemic foci, the place of compression of the arteries.

Treatment of cervical migraine

Artery compression Before the appointment of therapy, you will be given a comprehensive diagnosis, because on the basis of only symptoms, the doctor can not make such a serious diagnosis. If there are suspicions of a violation of the blood circulation of the brain, the patient is urgently hospitalized. After identifying and diagnosing the cause of the development of the vertebral artery syndrome, the doctor prescribes an individual course for the treatment of cervical migraine, which may include.
  • Wearing the collar of Shantz is a special orthopedic corset that reduces the burden on the cervical region, facilitating pain in osteochondrosis and other vertebral disorders;
  • Acupuncture will reduce pain in the thoracic region, eliminate dizziness;
  • Manual therapy. This method is not suitable for everyone and is prescribed only after consultation with a neurologist and a complete diagnosis. It helps to restore the anatomically correct location of the vertebrae;
  • Therapeutic exercise will strengthen the muscles of the cervical vertebrae. Patients are recommended to use special orthopedic accessories for sleep, which will help relieve tension in muscles and eliminate pain syndrome in osteochondrosis;
  • Physiotherapy and reflexology;
  • Medication removes the cause that led to the syndrome of the vertebral artery. Prescribe analgesics, anti-inflammatory, and in some cases, improving blood flow drugs.
In cases where clinical treatment does not bring the expected results, it is necessary to resort to surgical intervention. Without this method, the cases when the arteries are compressed by tumors or osteophytes can not be avoided.

Preventive maintenance of disease

  • With frequency of a minimum time in half a year to pass a session of massage of a collar zone;
  • For sleep, use only an orthopedic pillow, do not sleep on the stomach;
  • Perform a set of preventive exercises, especially for office workers leading a sedentary lifestyle;
  • Preferably, at least once a year, take a course of preventive treatment in a sanatorium, a neurological orientation.
"Important! With vertebral artery syndrome, it is strictly forbidden to take alcohol-containing drinks. "Remember, the key to success in the treatment of vertebral artery syndrome is timely diagnosis and properly prescribed therapy by a qualified specialist. These actions will prevent the development of the disease and their complications.


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