Introduction
When one thinks of dizziness or vertigo, the typical image of a person swaying or losing balance or even someone vomiting comes to mind. These types of issues are also quickly associated with something abnormal with the ears. The famous ear crystals are often at the forefront of the discussion.
“Do the Epley’s maneuver, it cured aunt Jane’s vertigo,” might you have been told by uncle Rob.
Although dizziness and vertigo can certainly be caused by something wrong with the ears, it is not always. As a matter of fact, vertigo and dizziness can also be caused by something abnormal with the eyes, but that won’t be the subject of this article. No, this article will focus on the 3rd and largely overlooked cause of these issues, the neck.
I often get emails or patients will ask me during a consultation if their neck pain could be associated with their dizzy symptoms. Or if a “pinched nerve” could be the source of their vertigo. I have also heard many times someone tell me their symptoms began after an accident or injury, sometimes a whiplash, others a concussion, some also report a very benign trauma (they definitely don’t call it a trauma themselves) where they bumped their head on something or their kid (or wife) fell on their neck. Ouch…
If this sounds like you or someone that you know, this article will be rather shocking and will teach you much little-known information. If that isn’t you, well, I promise to keep it entertaining while educational! And if you know someone suffering from dizziness or vertigo, don’t be a hoarder, pass them information!
The Epley’s maneuver is also known as canalith repositioning maneuver/procedure. It is a maneuver where the head is turned and moved in an effort to reposition the crystals inside one’s ear. This is great if the person suffers from Benign Paroxysmal Positional Vertigo (BPPV) but otherwise, it will be of little use.
Article Outline
- Defining dizziness, vertigo and cervicogenic dizziness/vertigo
- Cervicogenic dizziness symptoms
- The 3 systems maintaining balance
- The neck as the origin of dizziness or vertigo
- Other causes of cervicogenic dizziness
- Risk factors for developing cervicogenic dizziness
- Cervicogenic dizziness assessment
- Cervicogenic dizziness care
- Will I recover?
- Cervicogenic dizziness treatment near me
Defining Dizziness, Vertigo and Cervicogenic Dizziness/Cervical Vertigo
First thing first, slightly boring definition…
Dizziness is defined as: “[…] a term used to describe a range of sensations, such as feeling faint, woozy, weak or unsteady” by the Mayo Clinic
Vertigo is defined as: “[…] a sensation that the environment around you is spinning in circles” by the Cleveland Clinic
Cervicogenic dizziness, also called cervical vertigo, is the medical term used when dizziness, or less often vertigo, is caused by a neck-related problem. Cervicogenic dizziness can also occur following a cervical spine injury. Though, in most cases, symptoms don’t appear until months or years after the initial trauma.
*I think it is important to note here that neck pain is frequently associated with cervicogenic dizziness but not always. “Cervicogenic” means, in its simplest terms, originating from the neck.
Cervicogenic Dizziness Symptoms
As with any type of dizziness, certain symptoms are typical but some are also unique to cervicogenic dizziness. All individuals are different and symptoms can vary from person to person however the below list applies to most:
Common symptoms:
- Unsteadiness, light-headedness, motion sensitivity (this applies to you moving or something moving while you are steady. For example, a train going by in front of you)
- Neck pain and/or tenderness. The symptoms of dizziness usually worsen as the neck pain/tenderness does.
- Dizziness will start or worsen with specific head movements/positions. Often, tilting the head back or looking up is the most irritating position. (You know, when you go to the hair stylist or barber shop and they put your head in the sink…not so good…)
- Tense neck muscles and/or tender trigger points. (These can also be at the front of the neck)
- “Pinching” feeling or “catching” feeling when moving the neck in certain directions; often left or right or sideways
- Usually, the dizziness is not constant and will come in bouts.
- Unless the dizziness began after an accident, injury or trauma, the symptoms are progressive rather than sudden
- The symptoms can be worse at the end of the day (or in the morning if you’ve played video games all night!) when the neck is tired.
- The symptoms can worsen by computer work or technology usage; or any activity involving a seated position, bad posture and looking down too much
Less common symptoms:
- Migraine triggering dizziness
- Nausea
- Headaches (at the back of the head or across the forehead)
Rare symptom:
- Spinning feeling (vertigo)
The 3 Systems Maintaining Balance
The human body requires constant input and information from 3 different systems to maintain balance and steadiness.
These 3 systems are:
The vestibular center (ears and associated structures)
The eyes
The neck and the receptors in its joints and muscles
If one of these systems is dysfunctional, dizziness or vertigo can result. Cervicogenic dizziness/cervical vertigo happens when the neck is the main source of the issue.
The Neck as the Origin of Dizziness or Vertigo — Cause NËš 1: Proprioception
The joints and muscles of the neck are packed with sensors called proprioceptors. These detect motion and position of the neck. When the messages sent to your brain by the eyes and ears do not match the messages sent by your neck proprioceptors, there is an information mismatch. This mismatch creates confusion and this is the most common cause of cervicogenic dizziness.
Proprioception is the way your brain comprehends where your body is in space. They are mainly found in muscles and joints. The area of the body most dense with these small receptors is the upper cervical spine — the uppermost aspect of the spine including the joints between the skull and the Atlas (C1); first vertebra of the neck and the Atlas and Axis (C2); second vertebra of the neck.
As a side note the feet have the second highest number of receptors, which is why barefoot walking can be so beneficial (whether you have dizziness/vertigo or not).
Proprioceptors located in the upper cervical spine joints and musculature are highly sensitive to:
joint malposition or abnormal motion and;
abnormal tension in muscles
As I wrote above, these receptors can start sending confusing messages to the brain about the position of the neck, abnormal joint motion and muscle tension. This mismatch in messages is what can ultimately give rise to dizziness or vertigo.
Other Causes of Cervicogenic Dizziness
1. Vertebral artery compression
The vertebral arteries snake up through both sides of the spine before they enter the base of the skull to bring blood to the vestibular centers and areas of your brain processing motion. A misalignment of the upper cervical spine (upper neck vertebrae), compressing one or both arteries, can reduce blood flow to the ear organs or brain and cause dizziness or vertigo.
2. Sympathetic nervous system dysfunction
The sympathetic nervous system is responsible for the “Fight or Flight” response. If overly stimulated, it can lead to dizziness or vertigo. Important sympathetic nerves are found in the upper neck and can be affected by a misalignment of the upper cervical spine.
3. Migraine
About 1/3 of migraine sufferers also battle dizziness. There is increasing evidence linking dysfunctions of the neck and brainstem nerves with migraines and dizziness. I do a deep dive into headaches and migraines in my article Headache? Probably a Neck Problem.
4. Chronic neck pain
Pain (nociception) can, when chronic, affect different messaging pathways throughout the body. Nociception can interfere with normal messaging between your neck and brain and lead to dizziness.
Risk Factors for Developing Cervicogenic Dizziness
- Accidents, injuries or neck trauma such as Whiplash Associated Disorders (WAD)
- Concussions or other head injuries
- Contact sports
- Poor posture and regular seated position
- Neck muscle weakness
- Arthritis of the neck spine
Cervicogenic Dizziness Assessment
There are no specific tests or procedures to identify cervicogenic dizziness. It is more so a diagnosis of exclusion which means that other possible causes of the ailment have been ruled out. This makes the assessment tricky and requires a professional who will be able to exclude other possibilities while identifying risk factors and indicators of neck-related problems.
In our clinic, we perform:
- a full detailed history of your dizziness and your neck complaints
- screen for indications of other types of dizziness and vertigo
- screen for risk factors leading to cervicogenic dizziness
- perform a neurological and physical examination of the head and neck, including cranial nerve testing, joint range of motion, and muscle palpation
- detailed upper cervical X-ray evaluation to identify the presence of a spine misalignment
Cervicogenic Dizziness Care
A focus on the neck’s joints and muscles is at the forefront of any cervicogenic dizziness care. Below are some of the methods/techniques applied.
Upper Cervical Care
That is always the first step we take, and, in our opinion, the most important. The upper cervical spine misalignment must be at the very least reduced, if not corrected, to give the best chance to your body to heal. Aligning the spine reduces joint friction and “stickiness,” muscle imbalance and restores normal nervous system functions.
Soft Tissue Therapy
We commonly see patterns of muscle dysfunction in our patients suffering from cervicogenic dizziness. Even though correcting the misalignment of the spine goes a long way in helping reestablish balanced tension throughout the muscular system, a bit of help is sometimes necessary. Soft tissue therapy is a form of gentle muscle/fascia work done in conjunction with your upper cervical care.
Posture Imbalance Correction
Poor posture and poor work/gaming ergonomy can often increase your symptoms of dizziness and slow down your recovery. These issues we see with most of the population (not just cases of cervicogenic dizziness) can worsen muscle tension, and joint irritation and can even contribute to nerve dysfunction. Forward head posture (FHP) is the most common problem we see and strive to improve.
Physical Therapy/Vestibular Therapy
Physical therapy can be a great asset in helping with cervicogenic dizziness. Stretching and strengthening different muscle groups of the neck can greatly improve one’s recovery. Exercises to stabilize joints of the neck can be helpful as well.
Acupuncture
Acupuncture can help reduce pain, and muscle spasms and increase blood flow.
Surgery
In some rare cases, when there is the presence of artery compression or nerve compression, surgery might be warranted. This is of course a last resort option and patients who need this are few and far between.
Will I recover?
This is likely the burning question on the tip of your tongue. Luckily, if there are no complicating factors, you will fully and permanently recover from cervicogenic dizziness. However, some factors may contribute to the chronicity of the issue and may cause relapses. Some of these are:
- Highly damaged spinal joints
- Not correcting poor posture and bad technology/gaming habits (looking down too much, mainly)
- Playing contact sports
- Poor management of migraines
- Unmanaged blood sugar variations
- Unaddressed stress and anxiety
- Medication causing dizziness
Cervicogenic Dizziness Treatment Near Me
Atlas Spine and Wellness Care has experts in the assessment and care of cervicogenic dizziness and cervical vertigo. Our upper cervical chiropractors are highly skilled in the gentle correction of the upper cervical spine misalignment and soft tissue therapy.
Until you’ve tried upper cervical chiropractic, you haven’t tried everything! Click here to book a free consultation today and get better faster.
References
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- Li Y, Peng B. Pathogenesis, diagnosis, and treatment of cervical vertigo. Pain Physician. 2015;18(4):E583-595.
- Sung, Y.-H. Suboccipital Muscles, Forward Head Posture, and Cervicogenic Dizziness. Medicina 2022,58,1791.
- Sung YH. Upper cervical spine dysfunction and dizziness. J Exerc Rehabil. 2020 Oct 27;16(5):385-391.
- Galm R, Rittmeister M, Schmitt E. Vertigo in patients with cervical spine dysfunction. Eur Spine J. 1998;7(1):55-8.
- SELBY G, LANCE JW. Observations on 500 cases of migraine and allied vascular headache. J Neurol Neurosurg Psychiatry. 1960;23(1):23-32.
- Humphreys and Peterson: Comparison of outcomes in neck pain patients with and without dizziness undergoing chiropractic treatment: a prospective cohort study with 6 month follow- up. Chiropractic & Manual Therapies 2013 21:3.
- Endo K, Ichimaru K, Komagata M, Yamamoto K. Cervical vertigo and dizziness after whiplash injury. Eur Spine J. 2006;15(6):886-890.