Cervical vertigo, also known as cervicogenic dizziness, is a condition that can cause both neck pain and dizziness. It is related to certain neck conditions and can also occur following a cervical spine injury. While the duration of this condition varies from person to person, proper diagnosis and treatment are essential for managing symptoms and improving quality of life.
Dizziness can be cervicogenic when it is closely associated with neck pain, neck injury or neck pathology after excluding other causes of dizziness. Many conditions of separate pathophysiological backgrounds can cause cervicogenic dizziness.
Symptoms of Cervicogenic Dizziness
Cervicogenic dizziness can cause symptoms such as palpitations, nausea and vomiting due to autonomic nervous disorder.
- Palpitations
- Nausea
- Vomiting
- Autonomic nervous disorder symptoms
- Cardiovascular symptoms
- Gastrointestinal symptoms
Neuroanatomic studies have found connections between the vestibular nucleus, central cervical nucleus, reticular formation and parabrachial nucleus.
This suggests that a sensory mismatch between the vestibular, visual and neck proprioceptive systems can affect the reticular formation and parabrachial nucleus function.
This can lead to abnormal sympathetic outflow causing cardiovascular and gastrointestinal symptoms. Additionally, sympathetic innervation is directly related to intrafusal fibers and can inhibit proprioceptive input of cervical muscle spindles.
Causes
The relationship between neck problems and dizziness can be explained by the role of proprioception in maintaining balance and orientation. Proprioception refers to the body’s ability to sense its position and movement in space. The neck muscles and cervical joints are important in providing proprioceptive input to the brain.
Dysfunction of cervical proprioception due to various neck problems can alter orientation in space and cause a sensation of disequilibrium.
Current theory suggests that episodes of dizziness are due to disturbed sensory afferents from the neck, leading to a sensory mismatch between cervical, visual and vestibular inputs. The diagnosis is dependent upon correlating symptoms of disequilibrium and dizziness with neck pain and excluding other vestibular disorders.
The proprioceptive signals of neck muscles and cervical joints play an enormous role in maintaining and fine-tuning a person’s orientation at rest and balance while in motion. Alteration in these proprioceptive signals seems to be responsible for the majority of cases of so-called ‘cervicogenic dizziness’.
The diseased cervical joints are shown to have a significantly higher concentration of Ruffini corpuscles which play a major role in proprioception.
Most of the time, cervical vertigo is quite manageable. Once a diagnosis is established, your healthcare provider will recommend personalized treatment to ease your symptoms. Depending on the cause and extent of your condition, you may need physical therapy, vestibular (inner ear) therapy or medication.
Diagnosis
Cervicogenic dizziness is a sensation of lightness or heaviness in the head or disequilibrium, accompanied by slight ataxia of stance and gait. It usually occurs episodically and can last from minutes to hours.
Specific neck movements or positions may reproduce it. Patients with cervicogenic dizziness often complain of neck pain, cervical stiffness, visual disturbances, nausea, vomiting, headaches, tinnitus and palpitation.
Physical examination may reveal neck muscle tension and tenderness, zygapophyseal joint tenderness, cervical movement restrictions and postural imbalance.
Cervicogenic dizziness is closely related to neck pain in time. Neck pain is a more specific but less sensitive symptom of cervicogenic dizziness. Patients with neck pain accompanied by dizziness have significantly higher disability and pain scores than patients without dizziness.
Diagnostic Criteria
- A. Clinical, laboratory, and/or imaging evidence of a disorder or lesion within the cervical spine or soft tissues of the neck known to be able to cause dizziness.
- B. Temporal coincidence of the appearance or increase in both neck pain and dizziness.
- C. Evidence demonstrated by at least two of the following:
- Dizziness has developed in temporal relation to the onset of the cervical disorder or appearance of the lesion.
- Dizziness has significantly improved or been resolved in parallel with an improvement in or resolution of the cervical disorder or lesion.
- At least two clinical diagnostic tests (cervical torsion test, cervical joint position error, or posturography) are positive.
- Dizziness is abolished following a diagnostic blockade of a cervical structure or its nerve supply.
- D. Exclusion of other possible sources of dizziness, including the vestibular, visual, central nervous system, or psychosomatic pathologies.
Pharmacological treatment
Cervicogenic dizziness can be treated with a variety of clinical drugs including non-steroidal anti-inflammatory drugs (NSAIDs), antidepressants and muscle relaxants. These drugs work in different ways to alleviate the symptoms of cervicogenic dizziness.
NSAIDs have analgesic and anti-inflammatory effects and can inhibit abnormal proprioception from muscle spindles. Antidepressants can improve emotional symptoms, reduce sympathetic outflow and inhibit proprioceptive input from neck muscle spindle afferents. Muscle relaxants such as iperisone can effectively relieve pain and stiffness in patients with cervical spondylosis.
Physical Therapy
Physical therapy is a treatment for patients with cervicogenic dizziness accompanied by cervical whiplash or degenerative disorders. It aims to reduce neck pain, muscle stiffness and spasms to improve activity and ability.
Various methods such as helical patches, therapeutic education and exercise, extension traction devices have been found to be effective in reducing neck disability and dizziness.
Manual therapy has been the most widely studied method for cervicogenic dizziness and has been found to restore normal movement of facet joints, reduce pain and decrease muscle hypertonicity. Vestibular rehabilitation can also enhance the vestibulo-cerebellar system to compensate for changes in neck proprioception afferents.
Conclusion
There is a close relationship between neck problems and dizziness. Neck conditions can alter the proprioceptive signals from the neck muscles and cervical joints leading to cervicogenic dizziness.
Cervicogenic dizziness is characterized by sensations of lightness or heaviness in the head or disequilibrium, accompanied by other symptoms such as neck pain and stiffness. It can be triggered by specific neck movements or positions and is closely related to neck pain.
MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.