I have noticed that my head is tilted to my right in most photos, even though at the time the photos were taken, I believed my head to be erect. If I move my head to be upright, I feel as though it is tilted to the left. I am strongly right-handed. What causes this delusion, and is it common?
• As an occupational therapist, I have seen many people who have had strokes subsequently lean their head and even their entire body to their unaffected, stronger side. Many people who have not had strokes also have a tendency to lean a little.
There are two factors at play here. First, the brain adapts to conditions. After leaning slightly for a period of time, the brain accepts this condition as normal and perceives the body to be upright.
Second, very right-dominant people use their right arm and hand more than their left, so they develop strength and muscle tension more on that side. Increased strength and tension in the upper trapezius and levator scapulae muscles, which connect the shoulder girdle to the head, can cause the head to tilt to the right, and the brain would soon adapt to accept this position as upright.
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Bonnie Clancy, Fort Myers, Florida, US
• There may be an anatomical explanation for your questioner’s head tilt. Our son was diagnosed at age 13 as having a rare anomaly of his C1 vertebra; it is open in the front and has a floating piece of bone instead of part of the left side. The anomaly was discovered in a neck X-ray, while neurologists looked for the cause of two strokes he had.
They suspected the problem was in his neck because, prior to the discovery, physical therapists often coached him to hold his head straight. Photos of him as a baby and young child reinforced their hunch: he had always held his head tilted to the left. The paediatric cervical spine specialist later confirmed that the C1 anomaly would cause a tip in the angle at which he holds his head.
The anomaly had indirectly caused his strokes by repetitively injuring his left vertebral artery. He has made a full recovery through time, hard work and a titanium microcoil implanted to protect the affected artery. Your correspondent’s experience may be “a delusion”, but evaluation by a spine specialist might be recommended.
Nancy Benz, Ramsey, Minnesota, US
This article appeared in print under the headline “Head lines”
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