Variations in the number, size and shape of the foramina transversaria of cervical vertebrae can affect the anatomical course of vital blood vessels and nerves, with the risk for pathological conditions, like vertebrobasilar insufficiency. This can result in compression of the vertebral artery during neck movements, which is characterised by headache, migraine, difficulties in swallowing, problems with speech and sight, balance disturbances and hearing disorders, among others. The aim of this study was to analyse the prevalence of the diverse anatomical variants of the foramen transversarium in 446 cervical vertebrae from the skeletal remains of 83 victims who died on the ancient beach of Herculaneum (Italy) during the eruption of Vesuvius Volcano in 79 CE. There were complete and incomplete double foramina transversaria in 20.6% of the vertebrae, and absence of foramen transversarium in an atlas (0.2%), a very rare condition in the literature. As the foramen transversarium is a key determinant for correct development of the vertebral artery, evaluations of variations in its number, size and shape provide useful information on the prevalence of these variations in the life and health conditions in the ancient population of Herculaneum.