Kimmerle’s anomaly is a rare and serious pathology of the 1st cervical vertebra, which may sometimes lead to hardly explicable changes in vertebrobasilar circulation. Also known as ponticulus posticus (PP), this phenomenon encircles the vertebral artery and suboccipital nerve and is associated with vertigo, vertebro-basilar insufficiency, neck pain, shoulder pain and cervicogenic headache symptoms. It can also lead to migraine as a result of its interaction with dura. As the knowledge of this variant by clinicians is important for obtaining a fast result in the treatment, it should also be taken into account in surgical approaches so as not to harm the vessels and nerves in this area