Cervical vertigo can be defined as vertigo caused by neck postures irrespective of the orientation of the head to gravity. Cervical vertigo can also be simply defined as vertigo due to neck disorders (Ryan and Cope, 1955).
The etiology of cervicogenic vertigo can be traced to pathophysiological changes in the inner ear, head or neck region.
Despite the somewhat ominous-sounding name, “cervicogenic vertigo” is simply a variety of dizziness brought on by conditions related to the neck (or cervico-), and one of several vestibular disorders (associated with the inner ear).Over the years, it's been named proprioceptive vertigo, cervicogenic vertigo, cervical dizziness but today it's generally termed cervicogenic dizziness (since true vertigo is rarely a symptom).
A relatively new classification in medical literature, diagnosis of cervicogenic dizziness frequently leaves patients wondering how the neck can possibly cause dizziness—which is easily explained:
Anatomically-speaking, neck muscles and joints contain tiny receptors whose job it is to continuously send signals to the brain, eyes, and inner ear (the “vestibular” apparatus) about head orientation: specifically, where the head is in relationship to the rest of the body.
The vestibular apparatus (part of a larger system responsible for controlling eye movement, muscle coordination, and general balance) relies on the eyes and mechanisms of the inner ears to inform the vestibular system as to the relative position of the head to one's surroundings.
Should any aspect of this system malfunction, inaccurate information is sent to the brain, causing sensory confusion; the physiological condition we refer to as “dizziness” or “light-headedness.”
Thus, if the neck (which is directly involved with this regulatory system) is experiencing stiffness or limited range-of-motion, the information it relays to the brain will be less than accurate.
Sometimes likened to carpenter's bubble level, if the orientation between the eyes, ears, and brain are not aligned, the information conveyed to the brain will not be a true reading of physical orientation.
Thus, neck-rooted “cervicogenic” dizziness results--indicating something askew.
Click here for a wider look at the cervicogenic dizziness and possible overlapping conditions
Among the symptoms commonly associated with cervical vertigo are:
- Dizziness related to neck movement, especially, dizziness caused by turning the head about the vertical axis or while sitting upright irrespective of the orientation of the head to the gravity..
- neck pain and/or stiffness
- A sense of spinning of the surrounding environment.
- Nausea and Vomiting
- Persistent unsteady disposition and loss of balance while walking, standing and sitting.
- Ear pain and Tinnitus characterized by ringing, swishing, or other noises originating in the ear or head.
- Distorted vision and visual disturbances while shaking the head, spots in the vision field and loss of vision in half of the visual field.
- Ear congestion
Symptoms are usually aggravated while standing up all of a sudden, during rapid neck movements, physical exercise, coughing and even sneezing.
At its most aggressive, cervicogenic dizziness can be quite disabling, with symptoms including:
- postural unsteadiness (aggravated by movement of the neck and/or spine),
- difficulty swallowing, temporomandibular (TMJ) joint pain,
- neuropathy of the arms and hands,
- debilitating fatigue,
- as well as anxiety and difficulty concentrating.
Cause of cervical vertigo
Numerous mechanisms have been put forth as the potential causes ofcervical vertigo.
Vascular compression of the vertebral arteries in the neck by the vertebrae and other structures (Sakaguchi and Kitagawa et al. 2003), especially, compression due to incongruity of the origin of the vertebral artery, an inconsistent course between the fascicles of either longus coli and bands of deep cervical fascia (Bogduk, 1986) have been shown to be associated with obstruction of blood flow while turning the neck.
Spasm of the vertebral arteries can occur due to their close association with the sympathetic trunk (Bogduk, 1986).
Vertebral arteries can also be damaged at the points in the upper cervical spine region,due to stressful stretching such as weight lifting that causes the vertebral artery to rupture.
It is interesting to note that sensory information from the neck is combined with vestibular and visual information to determine the position of the head on the neck, and space during routine life activities. Thus, abnormal sensory inputs as in case of tight neck or tension neck might increase input from muscle proprioceptors, and cause dizziness ( Koskimies et al, 1997). Similarly, whiplash injuries can also trigger deficits in reproducing neck position and inaccuracy in assessing neutral neck position (Loudon et al, 1997).
Cervical cord compression caused due to interaction of the ascending or descending tracts in the spinal cord with the cerebellum, vestibular nucleus or vestibulospinal projections is one of the chief reasons for cervical vertigo (Benito-Leon, 1996 and Brandt 1996).
It has been shown that leak of the cerebrospinal fluid due to tear of cervical root sleeve can lower the CSF pressure and cause dizziness and headache (Schievink et al. 1998).
High cervical disease (C1-C2) associated with cervical vertigo is common in patients with platybasia and rheumatoid arthritis.
It is suggested that any damage to the alar ligaments could cause cervical vertigo due to rotational instability in the craniocervical junction. It has been suggested that asymmetrical injuries could cause interaction of the neck with other types of vertigo resulting in dizziness. Further, it has also been shown that neck injury and pain can trigger migraine, and migraine can in turn cause episodes of Cervicogenic migraine induced vertigo. Injuries to the neck that damage structures associated to the ears, especially, the inner ear can also cause vertigo.
Also, it's worth to mentionCervical Spondylosis(neck arthritis or cervicogenic osteoarthritis) - age-related condition developed from wear and tear in cervical spine (neck). It affects joints and discs in your neck. Vertigo from cervical spondylosis is not a widely accepted phenomenon. If you'd like, you can read more about ithere.
Accurate diagnosis of cervical vertigo is possible primarily only by effective elimination of the other causes of vertigo such asvestibular neuritis (or, neuronitis), BPPV (benign positional vertigo), Meniere's disease, central vertigo and psychogenic vertigo.
Cervical vertigo associated with head injuries and neck injuries such aspost traumatic vertigo, whiplash injury or severe arthritisshould be definitely taken into account during diagnosis.
Although diagnosing cervicogenic dizziness can be relatively simple when physical symptoms are present and apparent (stiff neck, limited range-of-motion), assessing cause and severity can be tricky—as well as the choosing of appropriate treatment. While a stiff neck can result from an accumulation of stress or by simply sleeping with one's head in an awkward position, it can also be indicative of more serious conditions like a blocked artery, pinched nerve, prolapsed disc, or in rare cases, a potentially serious disease called meningitis (an infection of the membranes surrounding the brain and spinal cord, usually accompanied by headache, vomiting, fever, and abnormal sensitivity to light).
Additionally, when cervicogenic dizziness is a product of whiplash (following a moving vehicle accident), assessment of the severity of whiplash must precede (and even preclude) treatment.
Note: In that there are as yet no diagnostic tests designed to scientifically confirm cervicogenic dizziness, it is typically assigned to individuals who have experienced neck injury (with associated pain) and are complaining of dizziness, and for whom other causes of dizziness have been ruled out. Generally, individuals diagnosed with this condition tend to complain of dizziness that worsens with head movement or after maintaining one head position for an extended period of time (and often accompanied by headache). In most cases, the symptoms associated with cervicogenic dizziness (which can last minutes or hours) will decrease if neck pain is alleviated.
Physical examination of cervical vertigo cases reveals no spontaneous nystagmus, though there may be upbeating nystagmus supine (Hozl et al, 2009). Use of VNG test instead of ENG has been proved useful to document nystagmus associated with herniated disks when the head is turned upright. Head-Turning Upright Test is an important diagnostic procedure for cervical vertigo (Cherchi and Hain, 2010).
Laboratory tests include ENG, VNG, Audiogram, VEMP, OAE, Posturography, MRI-neck and brain and flexion/extension x-rays of neck. CT-angiography is being widely employed recently for detection of vertebral hypoplasia in cervical vertigo. Selective vertebral angiography has been the "gold standard test" for the cervical vertigo caused on account of compression of the vertebral arteries. MRA, Vertebral Doppler and Fluoroscopy of the neck are the other procedures in use (Sakaguchi et al. 2003). Dynamic Posturography has off late gained preference for the diagnosis of cervical vertigo (Kogler et al, 2000 and Alund et al, 1991).
Treatment of cervical vertigo
Management of cervical vertigo can be achieved by physical therapy that includesgentle mobilization,neckexercisesandtraining on proper posture(Karlberg et al, 1996).
Manual therapy has been a recent addition that has been shown to help cervical vertigo (Lystad et al, 2011).
Medical management of cervical vertigo includes muscle relaxants such astizanidine, cyclobenzaprine and baclofen. Tramadol, venlafaxine and nonsteroidals are also useful especially in arthritis or migraine patients. Surgical management of cervical vertigo is usually done by complex fusion maneuvers.
In the absence of more serious or contradictory symptomology, treatment of cervicogenic dizziness typically involves methods to correct the orthopedic dysfunction causing the sensory confusion; essentially, the restoration of pain-free, full range-of-motion of the neck muscles and surrounding joints through one of several commonly-used techniques.
Though many doctors opt to prescribe anti-dizziness drugs like Antivert for this condition, this approach is generally thought contraindicated in that such drugs do not address the underlying problem [which can lead to exacerbation of the injured area], and can limit the brain's natural ability to adapt to new conditions, and can lead to medication dependency.
In many cases, treatment for cervicogenic dizziness can be as simple as application of heat and/or ice packs, gentle massage/manipulation, stretching exercises, or basic neck/spine alignment (of a chiropractic style).
More severe cases are often treated with one of two specific manual therapy treatments:
- Mulligan’s Sustained Natural Apophyseal Glides (a therapist-applied passive manual technique based in remedial gymnastics), or
- Maitland’s Passive Joint Mobilizations (a therapist-applied physical manipulation technique focusing on the movements of the vertebral column and interaction between the nerves, discs, and joints).
Additionally, in cases where this condition has been brought on by bad posture, general lifestyle changes may be in order (including instruction in proper posture and use of the neck), or in cases where the vestibular apparatus is malfunctioning (discovered through examination), eye exercises, balance/rehabilitation exercises, and/or walking exercises may be prescribed.
Although cervicogenic dizziness can usually be corrected within a relatively short period of time (a few days), a number of factors can affect total recovery time including the patient's overall physical condition, medical history, lifestyle, and general health, as well as preexisting conditions such as chronic migraines, P.O.T.S (a condition in which a change from the reclining to upright position causes a dangerous jump in heart rate, drop in blood pressure, and fainting), and fibromyalgia (as well as other forms of arthritis).
Here's the video that may help you to understand the problem all visually:
Cervical vertigo, or cervicogenic dizziness, is a neck-related sensation in which a person feels like either they're spinning or the world around them is spinning. Poor neck posture, neck disorders, or trauma to the cervical spine cause this condition.Can a pinched nerve in your neck cause dizziness and vertigo? ›
Fun fact: You may have asked yourself a question like, 'can a pinched nerve cause dizziness' and the answer is yes–under certain conditions a nerve in the neck experiencing excess pressure can cause bouts of 'cervicogenic' dizziness.What is cervicogenic dizziness like? ›
Cervicogenic dizziness is characterized by the presence of imbalance, unsteadiness, disorientation, neck pain, limited cervical range of motion (ROM), and may be accompanied by a headache [2, 3]. The cervical spine may be considered the cause of the dizziness when all other potential causes of dizziness are excluded.Can vertigo be caused by tight neck muscles? ›
Cervical vertigo, also called cervicogenic dizziness, is a feeling of disorientation or unsteadiness caused by a neck injury or health condition that affects the neck. It's almost always accompanied by neck pain. Your range of motion can be affected, too, and sometimes it comes along with a headache.Can a neck adjustment help vertigo? ›
Chiropractic adjustments or manipulations may help alleviate a specific type of vertigo called cervical vertigo. This type of vertigo is caused by improperly-moving joints in the cervical spine following a neck injury, which results in incorrect information about movement and body position being sent to the brain.How do you fix cervicogenic dizziness? ›
When diagnosed correctly, cervicogenic dizziness can be successfully treated using a combination of manual therapy and vestibular rehabilitation. We present 2 cases, of patients diagnosed with cervicogenic dizziness, as an illustration of the clinical decision- making process in regard to this diagnosis. )How do you test for cervicogenic dizziness? ›
The test is performed with the patient sitting on a swivel chair. Provocation of dizziness with trunk rotation under a head stabilized in space implicates the cervical spine, whereas dizziness with head and trunk rotation together (en bloc rotation) indicates a vestibular component to the patient's symptoms.Can C5 C6 cause lightheadedness? ›
MRI of the neck revealed a C5-C6 disk herniation, abutting the thecal sac. Comment: Nystagmus in this case does not begin immediately but starts after about 10 seconds of head turning. This is the most common association between neck injury and dizziness.Can a chiropractor help with cervicogenic dizziness? ›
Conclusion. This case study suggests that a patient with nonresponsive cervicogenic dizziness might respond to chiropractic spinal manipulative therapy approach using Gonstead method.What causes cervical instability? ›
There are a number of potential causes and risk factors for cervical instability, the most common of which include: Trauma: A car accident, whiplash, or another similarly traumatic episode can damage the cervical spine, disrupt the ligaments, and ultimately lead to chronic cervical instability.
Cervical instability is very reversible cause of many neurological symptoms and syndromes.Can neck cervical be cured? ›
Although there are several very good nonsurgical and surgical treatment options available to relieve the symptoms of cervical myelopathy and radiculopathy, there is no cure, per se, for the degenerative changes in the cervical spine that caused the symptoms.How do you check neck proprioception? ›
Joint Position Sense Assessment | Cervicogenic Dizziness - YouTubeHow do I know if my vertigo is neurological? ›
If you are dizzy right now and have any of the following neurological symptoms along with your dizziness or vertigo, call 911 immediately: New confusion or trouble speaking or understanding speech. New slurred speech or hoarseness of voice. New numbness or weakness of the face, arm, or leg.Is vertigo a symptom of cervical spondylosis? ›
Osteoarthritis. Advanced osteoarthritis in the area may lead to cervical spondylosis. This causes the vertebrae in the neck to wear down, which can put excess pressure on the nerves, arteries, or spinal cord itself. This could send inappropriate signals to the brain or block the flow of blood, causing vertigo.How is cervical vertigo diagnosed? ›
The test with the strongest diagnostic utility to rule in the diagnosis of cervicogenic dizziness is the cervical neck torsion test (LR+ of 9), which measures nystagmus in response to cervical neck rotation .What is the root cause of vertigo? ›
Vertigo is commonly caused by a problem with the way balance works in the inner ear, although it can also be caused by problems in certain parts of the brain. Causes of vertigo may include: benign paroxysmal positional vertigo (BPPV) – where certain head movements trigger vertigo. migraines – severe headaches.What nerve damage causes vertigo? ›
Vestibular neuritis is a condition that causes vertigo and dizziness. It results from inflammation of your vestibular nerve, a nerve in the ear that sends information to your brain about balance. When it's inflamed, this information isn't properly communicated, making you feel disoriented.What nerve controls vertigo? ›
The vestibulocochlear nerve sends balance and head position information from the inner ear (see left box) to the brain. When the nerve becomes swollen (right box), the brain can't interpret the information correctly. This results in a person experiencing such symptoms as dizziness and vertigo.How do you fix cervicogenic dizziness? ›
When diagnosed correctly, cervicogenic dizziness can be successfully treated using a combination of manual therapy and vestibular rehabilitation. We present 2 cases, of patients diagnosed with cervicogenic dizziness, as an illustration of the clinical decision- making process in regard to this diagnosis. )
Barré-Liéou and Cervicocranial syndrome are due to cervical vertebral instability, which affects the function of the nerve cell aggregations located in the neck just in front of the vertebrae. Vertebral instability or misalignment occurs because the ligaments that support the neck become weakened or injured.How long does BPPV last without treatment? ›
In about half of all people who have BPPV, the symptoms go away after only 1 to 3 months. So treatment isn't always needed. If the dizzy spells don't go away on their own or are very difficult for the person to cope with, repositioning maneuvers can help.What are the three types of vertigo? ›
Types of Vertigo: Peripheral, Central, BPPV, and More.What neurological disorders cause balance problems? ›
- decreased blood flow to the brain due to stroke or a chronic condition such as aging.
- traumatic brain injury.
- multiple sclerosis.
- Parkinson's disease.
- cerebellar diseases.
- acoustic neuromas and other brain tumors.
If you are dizzy right now and have any of the following neurological symptoms along with your dizziness or vertigo, call 911 immediately: New confusion or trouble speaking or understanding speech. New slurred speech or hoarseness of voice. New numbness or weakness of the face, arm, or leg.How do you know if your vestibular nerve is damaged? ›
The vestibular nerve communicates messages about head position and motion from your inner ear to your brain. When this nerve is damaged, these messages become jumbled and inaccurate, confusing your brain and producing the dizziness, nausea and movement issues.Does the vagus nerve have anything to do with vertigo? ›
Vagus nerve stimulation may reduce vertigo during vestibular migraine attacks.How can you tell the difference between BPPV and vestibular neuritis? ›
BPPV vs Vestibular Neuritis - YouTubeHow can you tell the difference between peripheral and central vertigo? ›
Patients with peripheral vertigo have impaired balance but are still able to walk, whereas patients with central vertigo have more severe instability and often cannot walk or even stand without falling.What causes neurological vertigo? ›
Central vertigo is due to a problem in the brain, usually in the brain stem or the back part of the brain (cerebellum). Central vertigo may be caused by: Blood vessel disease. Certain drugs, such as anticonvulsants, aspirin, and alcohol.