Cervicogenic Dizziness

john miller physiotherapist

Article by John Miller

What is Cervicogenic Dizziness?

Dizziness can result from your neck.

Dizziness is often associated with neck pain. However, it may be difficult to tell whether your dizziness and your neck pain are related or just coincidental. This is where an experienced physiotherapist with the skills to assess and treat both your neck pain and dysfunction plus any vestibular-origin dizziness is important.

The influence of your head position on equilibrium has been known since the mid-1800s.1 However, a clinical syndrome relating neck pain and/or injury to dizziness and disequilibrium was not discussed until the 1950s.

Ryan and Cope2 described a syndrome of disequilibrium and disorientation in patients with many different diagnoses of neck pathology including cervical spondylosis, cervical trauma, and cervical arthritis. They introduced the syndrome as cervical vertigo. However, since true “spinning vertigo” is rarely associated with this syndrome, cervicogenic dizziness is a more correct name for this syndrome.

What are the Symptoms of Cervicogenic Dizziness?

People with cervicogenic dizziness tend to complain of:

  • dizziness (a sensation of movement of the self or the environment) that is worse during head movements or after maintaining one head position for a long time.
  • dizziness usually occurs after the neck pain and may be accompanied by a headache.
  • dizziness symptoms usually last minutes to hours.
  • a general imbalance that may increase with head movements and with movement in the environment.

Although no formal studies have been completed, true cervicogenic dizziness is thought to be rare.

How is Cervicogenic Dizziness Diagnosed?

Cervicogenic dizziness can be a controversial diagnosis because there are no specific diagnostic tests to confirm that it is the cause of the dizziness. It is a diagnosis of exclusion. Once other causes of dizziness have been ruled out, cervicogenic dizziness is the diagnosis is assigned to people who have neck injury or pain as well as dizziness, or an illusory sense of motion and disequilibrium.3,4

An evaluation for cervicogenic dizziness involves a thorough medical evaluation because the symptoms are similar to other causes of dizziness.

Vestibular Testing

Testing of the vestibular system in your inner ear is usually requested to ensure that the peripheral or central vestibular system is intact. Your vestibular physiotherapist or an ENT (Ear Nose & Throat specialist) can perform different clinical tests and manoeuvres to see if it causes nystagmus (eye movements) or dizziness. The results of the clinical tests need to be correlated with subjective symptoms and the clinical findings because the test can also be positive in healthy individuals.5,6

Dizziness Post-Whiplash or Head Injury

Cervicogenic dizziness often occurs as a result of whiplash or head injury and is often seen in conjunction with brain injury or injury to the inner ear.4,7 It is often difficult to distinguish between cervicogenic dizziness and other medical problems.

Cervicogenic dizziness that occurs in conjunction with brain injury or another form of dizziness will be more difficult to diagnose and treat. It is important to be patient while health care professionals sort through the problems and treat them in the most logical order.

Cervicogenic Dizziness Treatment

The good news is that your cervicogenic dizziness will usually decrease when your neck pain decreases. The solution is therefore to fix your neck pain.

Neck Treatment

The majority of patients with cervicogenic dizziness improve with only treatment of the neck problem. Several studies have reported that approximately 75 percent of patients improve with conservative treatment of the neck such as medication, gentle mobilisation, exercise, and instruction in proper posture and use of the neck.8-10

Your physiotherapist is an expert in the treatment of cervicogenic dizziness. Please seek their advice and care.

Vestibular Treatment

For other patients, improvement involves treatment of the neck problem in addition to vestibular therapy. Vestibular rehabilitation is directed at what problems are found on evaluation and may include eye exercises, balance exercises, walking, and graded exposure to environments that make you dizzy.4

A vestibular physiotherapist is the best clinician for you to see if your require vestibular treatment for your dizziness.

Treatment Prognosis

Cervicogenic dizziness will usually resolve with treatment of the neck problem but may require vestibular rehabilitation for complete resolution of symptoms. In general, the prognosis for patients with cervicogenic dizziness is good, with 75 percent of patients having improvement of symptoms.

Your physiotherapist will be able to provide a guide following your assessment and how you respond to initial treatment. Please ask your physiotherapist for specific advice.

Common Causes of Vertigo & Dizziness

Due to the complex diagnostic skills required to accurately diagnose the cause of your vertigo or dizziness, we highly recommend seeking the professional opinion of a health practitioner with expertise in the assessment and managment of vestibular disorders.

Call PhysioWorks Book Online

References

  1. Brown JJ. Cervical contributions to balance: cervical vertigo. In: Berthoz A, Vidal PP, Graf W, editors. The Head Neck Sensory Motor System. Oxford University Press. 1992:644–647.
  2. Ryan MS, Cope S. Cervical vertigo. Lancet 1955; 2:1355–1358.
  3. Furman JM, Cass SP. Balance Disorders: A Case-Study Approach. Philadelphia: F.A. Davis, 1996.
  4. Wrisley DM, Sparto PJ, Whitney SL, Furman JM. Cervicogenic dizziness: a review of diagnosis and treatment. J Orthop Sports Phys Ther 2000; 30:755–766.
  5. Norre ME. Cervical vertigo. Diagnostic and semiological problem with special emphasis upon "cervical nystagmus". Acta Otorhinolaryngol Belg 1987;41:436–452.
  6. van de Calseyde P, Ampe W, Depondt M. ENG and the cervical syndrome. Adv Otorhinolaryngol 1977;22:119–124.
  7. Barnsley L, Lord S, Bogduk N. Whiplash injury. Pain 1994;58:283–307.
  8. Galm R, Rittmeister M, Schmitt E. Vertigo in patients with cervical spine dysfunction. Eur Spine J 1998;7:55–58.
  9. Karlberg M, Magnusson M, Malmstrom EM, Melander A, Moritz U. Postural and symptomatic improvement after physiotherapy in patients with dizziness of suspected cervical origin. Arch Phys Med Rehabil 1996;77:874–882.
  10. Wing LW, Hargrave-Wilson W. Cervical vertigo. Aust N Z J Surg 1974;44:275–277.

Share this page

Last updated 24-Jan-2017 04:49 PM

Receive Special Offers and the Latest Injury Information

Enter Details Below to Signup: