What is Cervicogenic Dizziness?
Dizziness may be caused by neck (cervical spine) dysfunction, which is known as cerviocogenic dizziness.
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 your neck pain and dysfunction plus any vestibular-origin dizziness is essential.
The influence of your head position on equilibrium has been known since the mid-1800s. (1) However, doctors did not discuss a clinical syndrome relating neck pain and/or injury to dizziness and disequilibrium until the 1950s.
Ryan and Cope (2) 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 the 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) worsens 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 typically 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 assigned to people who have neck injury or pain and 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.
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 due to 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 challenging to diagnose and treat. It is essential 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 alleviate your neck pain.
The majority of patients with cervicogenic dizziness improve with only treatment of the neck problem. Several studies have reported that approximately 75 per cent 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 may assist you in the treatment of cervicogenic dizziness. Would you please seek their advice and care?
For other patients, improvement involves treatment of the neck problem in addition to vestibular therapy. Vestibular rehabilitation is directed at what issues 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 you require vestibular treatment for your dizziness.
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 per cent of patients having an improvement of symptoms.
Your physiotherapist will provide a guide following your assessment and how you respond to initial treatment. Would you please ask your physiotherapist for specific advice?
Find out more about Vestibular Physiotherapy.
Article by Shane Armfield
Common Causes of Vertigo & Dizziness
Dizziness & Vertigo FAQs
- What is Vertigo?
- What is Dizziness?
- BPPV - Benign Paroxysmal Positional Vertigo
- Meniere's disease
- Neck dizziness (cervicogenic dizziness)
- Inflammation in the inner ear
- A vestibular migraine
- Vestibular neuritis
- Acoustic neuroma
- Rarely, vertigo can be a symptom of a more serious neurological problem such as a stroke or brain haemorrhage.
Due to the complex diagnostic skills required to diagnose the cause of your vertigo or dizziness accurately, we highly recommend seeking the professional opinion of a healthcare practitioner with a particular interest in assessing and managing vestibular disorders.
Article by John Miller
The symptoms of BPPV can include:
- Sudden episodes of violent vertigo.
- Dizziness and/or nausea.
- Movements of your head trigger vertigo.
- Your vertigo may last half a minute or more.
- Your eyes may drift and flick uncontrollably (nystagmus).
What Causes BPPV?
Inside your inner ear, there is a series of canals filled with fluid. These vestibular canals are at different angles. When your head is moved, the liquid rolling inside these vestibular canals tells the brain exactly how far, how fast and in what direction your head is moving.
BPPV is caused by little ‘ear rocks’ or otoconia (calcium carbonate crystals) within the vestibular canals.
Usually, these crystals are held in unique reservoirs within other inner ear structures (saccule and utricle). It is thought that injury or degeneration of the utricle may allow the ‘ear rocks’ to dislodge and escape into the balance organ and interfere with your vestibular system.
What Causes Your ‘Ear Rocks’ to Dislodge?
Factors that may cause or allow ‘ear rocks’ to migrate into your vestibular canals include:
- Head or ear injury.
- Ear surgery or ear infection, such as otitis media.
- Degeneration of the inner ear structures.
- Vestibular neuritis (viral infection of the inner ear).
- Meniere’s disease (a disorder of the inner ear).
- Some types of minor strokes.
In around half of BPPV cases, you can’t find the cause of your BPPV. This is known as idiopathic BPPV.
How is BPPV Diagnosed?
Dizziness and vertigo are common to many medical conditions, so careful differential diagnoses are essential. Your physiotherapist or doctor may use several tests to diagnose BPPV.
What is the Treatment for BPPV?
‘Ear Rock’ Relocation Techniques
After assessing you and confirming BPPV, your BPPV trained physiotherapist will apply specific techniques to relocate the "ear rocks" to an area in the inner ear that doesn't stimulate your feelings of dizziness or vertigo.
How Successful is BPPV Treatment?
When BPPV techniques are performed correctly, reducing your vertigo, dizziness, and other symptoms of BPPV is immediate in 80% or more of cases. Quality BPPV practitioners have a 90%+ success rate within three applications of the techniques.
Other BPPV Treatment Options?
Due to BPPV being caused by the physical presence of ear rocks within your vestibular canal, only the relocation of these ear rocks will clear your symptoms. You may find some drugs that can help you mask your BPPV symptoms by diminishing your sensitivity to your vestibular symptoms. They work similarly to seasickness medications. Would you please discuss this medicated option with your doctor?
Who Performs BPPV Treatment?
Some vestibular physiotherapists and doctors are trained in the assessment and treatment of BPPV. BPPV-trained physiotherapists undertake specific training to diagnose and successfully treat BPPV. PhysioWorks has several BPPV trained physiotherapists. Would you please call them to book your appointment with a BPPV physiotherapist?
Physiotherapy Private Health Insurance Rebates
PhysioWorks Physiotherapy and Remedial Massage are more affordable than you think. Your Private Health Insurance (PHI) usually pays for most of your treatment fees, leaving you with only a small gap payment.
However, Private Health Funds vary their rebates payable depending upon the level of cover you have taken. Some funds have kept up with the costs of modern medicine whereas, sadly, others haven't, with rebates similar to what they were a decade ago.
HICAPS - Instant Health Fund Claims
Most health funds are members of the HICAPS instant claims system. Swipe your health insurance card at our reception counter, and you can instantly claim your physiotherapy treatment via our online Hicaps System. Remedial Massage is claimable via Hicaps for some but not all funds. Please visit Hicaps for the latest funds for more information, which can use their instant claiming system.
Private health insurance rebates are available for all of our physiotherapists. Instant claims are possible via our in-practice Hicaps system.
- All Private Health Insurance Funds including BUPA, Medibank Private, HCF
- For a complete list of Hicaps instant claim funds, see here: Hicaps Funds
- HCF More for Muscles Program
PhysioWorks practitioners are registered providers for government, Workcover and insurance companies, including:
- Australia Post; Coles Myer; Woolworths
- Department of Veterans' Affairs
- CTP & Sports Insurers
The internet is full of potentially unreliable information. Please source trusted healthcare information from reputable websites such as the following.
- 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.
- Ryan MS, Cope S. Cervical vertigo. Lancet 1955; 2:1355–1358.
- Furman JM, Cass SP. Balance Disorders: A Case-Study Approach. Philadelphia: F.A. Davis, 1996.
- 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.
- Norre ME. Cervical vertigo. Diagnostic and semiological problem with special emphasis upon “cervical nystagmus”. Acta Otorhinolaryngol Belg 1987;41:436–452.
- van de Calseyde P, Ampe W, Depondt M. ENG and the cervical syndrome. Adv Otorhinolaryngol 1977;22:119–124.
- Barnsley L, Lord S, Bogduk N. Whiplash injury. Pain 1994;58:283–307.
- Galm R, Rittmeister M, Schmitt E. Vertigo in patients with cervical spine dysfunction. Eur Spine J 1998;7:55–58.
- 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.
- Wing LW, Hargrave-Wilson W. Cervical vertigo. Aust N Z J Surg 1974;44:275–277.