Lhermitte’s Sign

What is Lhermitte’s sign?

Lhermitte’s sign (pronounced “lair-meets-sign”) is a quick, painful, shock-like electrical sensation you feel along your neck and spine. It can spread to your arms and legs. You might feel this sensation when you tilt your head forward, cough or sneeze. It only lasts for a few seconds at a time, but can occur many times per day.

You may hear your healthcare provider refer to Lhermitte’s sign as Lhermitte’s phenomenon, barber chair phenomenon or acute paroxysmal pain.

Is Lhermitte’s sign dangerous?

Lhermitte’s sign isn’t dangerous or life-threatening. It doesn’t last long and may be lessened by avoiding movements that trigger it. This symptom can appear once or several times throughout your life depending on the cause.

Is there a test to diagnose Lhermitte’s sign?

There isn’t a specific Lhermitte’s sign test available. A healthcare provider may offer imaging tests to determine what caused this symptom, like an MRI (magnetic resonance imaging) scan.

Another test, called a spurling test, is sometimes used to diagnose some types of neck pain. A healthcare provider will guide your physical movements to see if the movements cause pain. A positive test result means you experienced neck pain during the test and likely have nerve compression in your spine.

What causes Lhermitte’s sign?

Damage to the nerves in the spinal cord causes Lhermitte’s sign. This nerve damage is known as a lesion, or “scar.” A healthcare provider may find a lesion in your neck (cervical spine) on an imaging test.

A lesion usually occurs due to demyelination (the destruction of myelin). Myelin is the protective cover around a nerve cell. Myelin helps messages pass from your brain to other parts of your body.

When this covering is damaged, certain neck movements may cause the affected nerve to overreact. It sends pain signals to your brain and makes you feel a shock-like sensation along your spine.

Common causes of Lhermitte’s sign include:

• An underlying condition affecting the spinal cord.
• A side effect of a medication or treatment (like chemotherapy or radiation therapy).

What conditions cause Lhermitte’s sign?

The most common condition that causes Lhermitte’s sign is multiple sclerosis (MS). Studies found that nearly 1 in 3 people diagnosed with MS experience Lhermitte’s sign at least once in their lifetime.

Other common conditions that cause this sensation include:

• Behçet’s disease.
• Cervical spondylitis.
• Chiari malformation.
• Herniated disk.
• Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).
• Neuromyelitis optica spectrum disorder (NMOSD).
• Shingles.
• Spinal cord compression.
• Transverse myelitis.
• Trauma or an injury.
• Vitamin B12 deficiency.

This isn’t an exhaustive list of all causes of this symptom. A healthcare provider will diagnose the underlying cause to help you treat it.

What triggers Lhermitte’s sign?

Certain movements can trigger Lhermitte’s sign or cause the sudden pain to start. These movements include:

• Bending your head down.
• Coughing.
• Sneezing.
• Yawning.

You may be more likely to experience this sensation when you’re:

• In warm temperatures.
• Exercising.
• Stressed.
• Tired.

How is Lhermitte’s sign treated?

Treatment for Lhermitte’s sign isn’t always necessary, as the sensation only lasts for a few seconds before going away.

Managing the underlying condition that causes this symptom can help you experience it less often. A healthcare provider might also recommend the following:

• Taking medications (like gabapentin).
• Pulsed electromagnetic field therapy, which sends waves of energy to the affected nerves.
• Wearing a neck brace to limit forward neck movements.
• Occupational or physical therapy to practice muscle relaxation techniques and stretching.
• Undergoing surgery to relieve compression around your spine.

As there are many possible causes, your healthcare provider will create a treatment plan that’s specific to your situation. What works for you to treat this symptom may be different from what works for someone else.

Can Lhermitte’s sign be prevented?

There isn’t a way to entirely prevent Lhermitte’s sign. Treating any conditions that lead to this symptom can reduce how often you experience it.

One way to prevent the symptom is to avoid things that trigger it, like bending your head forward. This isn’t always possible, as this is a very common movement.

You can also talk to your healthcare provider about ways to reduce coughing and sneezing, especially if you have allergies or an underlying illness that can make Lhermitte’s sign worse.

When should Lhermitte’s sign be treated by a doctor or healthcare provider?

If you experience an electrical sensation when you make certain movements without a known cause, visit a healthcare provider.

Contact a healthcare provider if you:

• Have an underlying condition that causes this symptom.
• Notice additional symptoms with this one.
• Feel that this symptom gets worse.