Background: Brain zaps have been described by patients as an electrical shock sensation within the brain.
- Some report a buzzing, ringing, or whooshing sound or a pulsing in their ear with the shock sensation.
- Some say they have a “brain shiver,” because the shock may be accompanied by a tremor, vibration sensation or a “shiver.”
- Some may feel faint, actually black out, or experience a brief or momentary dizziness or lightheadedness.
- Some say they get ringing, buzzing, or pulsing in the ear(s) during and after the brain zap.
Regardless of symptoms, people who have brain zaps, especially following the first one, are usually very frightened and become anxious about the cause of the zap.
Causes of brain zaps
For some, brain zaps may come with the discontinuation of various medications, including antidepressants, but for some, cervical spine instability may be the root cause. Research also suggests lateral eye movements may trigger brain zaps.
I’ve had patients recently with brain zaps who reported:
- Lateral eye or head movements can trigger brain zaps.
- Brain zap sensations may be controlled by the movement of your head and neck.
Signs that the brain zaps can be coming from the neck. But how?
In the image above:
- Ligament damage causes shifting of C1, which results in stress and compression of the internal jugular vein and vagus nerve.
- Cervical spine instability causes stretch/compression of the nerves that innervate the dura. These nerves, C1, C2, vagus, and trigeminal nerves, can be irritated and cause brain zapping.
The brain is surrounded by the dura mater or the meninges. Like a pinched nerve, the dura mater can be herniated and cause brain zaps. In my article, The myodural bridge and dural tension. A missing diagnosis of neurologic-like symptoms? I describe how the muscles of your neck and the nerve pathways they use to move your head may be causing a tugging on your spinal cord. This tugging can occur at the myodural bridge, a thick, dense collection of connective tissue that connects the muscles to the dura of the spinal cord.
The dura mater that surrounds the brain receives its nerve supply primarily from the trigeminal nerve (Cranial nerve V) and from the sympathetic nerve branches, other cranial nerves, and spinal nerves.
The sympathetic nerves originate in the neck primarily from the superior cervical sympathetic ganglion that sits right in front of the second cervical vertebrae and the third cervical vertebrae, as well as cranial nerve I (the olfactory nerve), cranial nerve II (the optic nerve), and the vagus nerve. Irritation of any of these nerves can cause brain zaps.
The vagus nerve sits right in front of the cervical vertebrae, so any sort of destructive change or broken neck structure, which I term cervical dysstructure, can put stretch or compression on the vagus, so that’s one cause of brain zaps if somebody has ligamentous cervical instability, so if you have clicking, popping, or grinding of your neck and you have brain zaps.
Upper cervical instability on the trigeminal nerve. The trigeminal nerve spinal cord tracts can go all the way to C3. Instability can cause a myriad of symptoms, including brain zaps in some.
- The trigeminal nerve originates in the brain stem, and its neurons go all the way down to the C2-C3 level in the spinal cord. Any sort of upper cervical problem can cause irritation of the cranial nerves.
- The C1 and C2 innervate the upper cervical muscles, and they also innervate part of the dura mater that surrounds the brain. Irritation of these nerves may then cause brain zaps.
The spinal accessory nerve innervates the sternocleidomastoid muscle in the trapezius if you’re somebody who has brain zaps and you also have tension in the neck and shoulders, this may indicate a problem in the upper cervical region including the atlas moving in ways that it’s not supposed to, possibly linking jugular vein and when it kinks the jugular vein, more symptoms can happen. This can include brain fog, headaches, and cognitive issues from decreased brain function.
I’m seeing more and more reports on people in their 30s in 40s that the brain MRIs are showing
white matter lesions, and white matter lesions have been shown to be a precursor to dementia and Alzheimer’s disease.
We get many emails from people asking about brain zaps. In one email, the person describes these zaps as like having electric coils firing in their brains for sometimes hours, debilitating them to the point that they can’t walk, talk, and have blurry vision.
When someone describes symptoms like this, including blurry vision. It may be the same pathophysiology, the same structural problem causing both the brain zaps and the blurry vision, both related to jugular vein compression.
When the brain zaps run down the neck
When people have neck pain and neck zaps, this is a good indication that they have upper cervical instability. If they have clicking, popping, or grinding in the upper cervical region, the body is going to try to reduce that motion through the ligamentous muscular reflex.
So the person turns his/her neck/head, and there is cervical instability at the atlas, the atlas moves too much, there’s a reflex between the ligament and the muscle, so the muscle clamps down to try to hold the neck in shape. This can cause the spasms and muscle tension associated with the brain zaps.
If you have clicking, popping in your neck, or you have tension in your upper neck, I would consider an evaluation looking for ligamentous cervical instability. At our center, we would suggest a digital motion x-ray. It’s basically a video recording of your cervical vertebrae in motion. Recommendations for treatments, including prolotherapy in the neck region and chiropractic, can be offered.
More on vision or eye movement causing brain zaps
A February 2022 study (1) from doctors at the University of California, San Diego, examined posts about brain zaps on a popular lay mental health website using questions specifically targeting brain zaps in a web-based questionnaire.
- 3,141 responses were examined from an online questionnaire
- The questions probed the specifics of the medications taken, the temporal characteristics of medication taken, the symptoms associated with the brain zaps, the specifics of the “zap” experience itself, and their effect on quality of life.
- In our previous study, eye movements triggering brain zaps emerged as an unexpected finding.
Lateral eye movement as a trigger emerged with even more clarity than in the previous study. The positive correlation between the time from onset of the brain zaps and the half-life of the drugs strongly suggests that brain zaps are indeed associated with antidepressant discontinuation.
There is now an even stronger indication that brain zaps are typically triggered by lateral eye movements, which may open avenues for investigating this process.
Withdrawal from antidepressants causes brain zaps
A 2018 study in the journal Primary care companion for central nervous system disorders (2)
Venlafaxine and paroxetine were reported more frequently, and fluoxetine less frequently, in the sample compared to their frequency of prescription in clinical practice. This finding mirrors the frequency distribution of all withdrawal effects versus antidepressant prescriptions written as reported in the literature. The most likely cause of brain zaps was abrupt discontinuation of the medication, but gradual tapering had only a partial mitigating effect.
Lhermitte’s sign, Lhermitte’s phenomenon, barber chair phenomenon
Lhermitte’s sign is an electric shock sensation from the head, through the neck, and down the spine. For many, this shock comes when the neck is flexed, sometimes as simply as when looking down. Most of the research on patients with Lhermitte’s sign focuses on it as a symptom more common in multiple sclerosis patients. However, research has shown Lhermitte’s sign can be caused by cervical disc disease, cervical spondylitis, chairi malformation, spinal cord compression, etc. Conditions of cervical spine instability.
A much-cited 2015 paper in the Indian Academy of Neurology (3) wrote: “The pathophysiology of Lhermitte’s sign was described as the stretching of the hyperexcitable demyelinated (damaged nerve coatings) dorsal column of the spinal cord, particularly at the cervical level, thus triggering an electric shock-like sensation.”
Stretching and damage to the nerves and the myelin sheath may be a sign of cervical spine instability as the main cause of Lhermitte’s sign in some patients.
Read more:
References
1 Papp A, Onton JA. Triggers and characteristics of brain zaps according to the findings of an internet questionnaire. The Primary Care Companion for CNS Disorders. 2022 Feb 10;24(1):39597. [Google Scholar]
2 Papp A, Onton JA. Brain Zaps: An Underappreciated Symptom of Antidepressant Discontinuation. The Primary Care Companion for CNS Disorders. 2018 Dec 20;20(6):18m02311-. [Google Scholar]
3 Khare S, Seth D. Lhermitte’s sign: the current status. Annals of Indian Academy of Neurology. 2015 Apr 1;18(2):154-6. [Google Scholar]