A 50-year-old male with a long standing history of compulsive Valsalva maneuvers, complaining of episodes of vertigo underwent head computed tomography. Axial CT slices at the level of the skull base (Fig. A) and the first cervical vertebrae (Fig. B) shows an extensive unusual pneumatization of both the body and lateral processes of the first cervical vertebrae (arrows), with air pouches dissecting planes between bone cortex and the periosteum around the occipital bone and the lateral processes of the first cervical vertebrae (arrowheads). These pneumatoceles cause no compression to the central nervous system and the cranial nerves.