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by Joon Nah   BScPT
Certified Vestibular Physiotherapist
updated May 9, 2022


What is Cervicogenic Dizziness?

Cervicogenic dizziness is the term used for conditions where dizziness is caused by a neck-related problem. Cervical Vertigo is another commonly used term for this condition, but is less preferable, as vertigo (which refers to a spinning sensation) is not typical to most cases of cervicogenic dizziness or CGD.

Cervicogenic dizziness is considered a controversial diagnosis as some physicians, researchers and rehabilitation specialists continue to have doubts as to whether the neck can truly be the source of dizziness symptoms. However, anecdotally the number of patients that fit this model and respond to neck-directed treatment is high. Additionally, research within the last 10 years seems to support the diagnosis of cervicogenic dizziness as legitimate.

 

Cervicogenic Dizziness Symptoms

As with most conditions, patients with cervicogenic dizziness don’t always have identical symptoms, patterns or disease progressions. However the following are can be applied to most individuals:

Usually

  • Dizziness, motion sensitivity, light-headedness
  • Symptoms reported as vague or hard to describe
  • Neck stiffness and/or pain. Dizziness usually increases when neck symptoms increase.
  • Tender trigger points or tense muscle tissue in the neck
  • Dizziness with head movements (especially extending your neck back) or placing your head in poor postures for long periods of time
  • Symptoms last for minutes to hours
  • Symptoms are not constant but rather occur in episodes
  • Unless there is neck trauma, symptoms occur gradually over time, rather than sudden, strong bouts of dizziness

 Sometimes

  • Headaches, particularly at the back of the head and/or on one side of the head, radiating toward the front
  • Nausea

Rarely

  • Spinning type of vertigo symptoms

Unlikely to be Cervicogenic Vertigo

  • Tinnitus or hearing loss
  • Migraines
  • Significant visual issues (double vision, unsteady or shaky vision)

 

What causes cervicogenic dizziness?

Your head has a sense of how it’s positioned in space and in which direction it’s moving from 3 main systems in your body.

1) Your vestibular system (inner ear organs)
2) Receptors in your neck (proprioceptors)
3) Your vision

When one of more of these systems are malfunctioning than it can produce sensations of dizziness, imbalance and instability. Cervicogenic dizziness occurs when your cervical spine (neck) is the main area of malfunction.

The joints in your neck contain sensors that help to detect position and motion.  Your brain gets confused when there is a mismatch between your head’s motion sensors (vestibular system) and your neck’s motion sensors, resulting in dizziness. This “confusion” is the most common cause of cervicogenic dizziness.

 

Specific Causes of Cervicogenic Dizziness

1) Degenerative Disc Disease of the Neck

Osteoarthritis and other joint related issues of the neck are a primary cause of errors in proprioception (joint position sense) which lead to cervicogenic dizziness.

2) Sympathetic nervous system impairments (e.g. Barre–Lieou syndrome)

The sympathetic nervous system regulates our body’s “fight or flight” response including pupil dilation, increased heart rate/palpitations, poor or slow digestion and sweating. When these nerves get compressed in the neck and nearby spinal cord from neck joint and disc issues, dizziness can result.

3) Compression of arteries in the neck (e.g. Bow hunter’s syndrome)

This commonly occurs through diseases such as atherosclerosis and blood clots (thromboemboli) and is sometimes due to arthritis in the neck joints. This reduced blood flow to your vestibular organ or to the areas of your brain that process motion information can result in dizziness symptoms.

4) Migraine Associated Vertigo (neck variant)

There is a recent increase in evidence that a specific type of migraine related to the neck and your jaw/facial nerve can produce cervicogenic dizziness.

5) Chronic neck pain

Conditions that produce persistent neck pain, over time can interrupt the normal signals between your neck and the balance centres in your brain, resulting in dizziness. This type of cervical vertigo can even remain after the chronic neck pain itself has resolved.

6) Myofascial Pain Syndrome (MPS)

This condition is is related to painful trigger points in muscle tissue in the neck and upper shoulders. Specifically your sternocleidomastoid neck muscles and trapezius muscles.

 

Risk factors for getting cervicogenic dizziness

  • Poor posture
  • Whiplash Associated Disorders (WAD) or other traumatic injuries to the neck
  • Concussions or other head injuries
  • Weakness of neck muscles
  • Osteoarthritis of the neck joints
  • Inflammatory diseases that affect the neck such as rheumatoid arthritis and ankylosing spondylitis

 

How is cervicogenic dizziness diagnosed?

There is no single test or procedure that can diagnose cervicogenic dizziness, rather it is a diagnosis of exclusion. This means that all other possible causes of dizziness are ruled out, which then rules in cervical vertigo as the most likely diagnosis. Dizziness has many different causes. Here is a link to 10 common causes of dizziness.

One issue with diagnosis is that cervicogenic dizziness is similar to many other vestibular disorders. In fact, many other dizziness problems include neck pain as a symptom without any issues of cervicogenic dizziness present. This includes the following diseases among many others:

Vestibular Migraine
Meniere’s disease
Persistent Postural Perceptual Dizziness (PPPD)
Mal de Debarquement (MdDS)
Vestibular hypofunction from Vestibular Neuritis

This makes the assessment process tricky and requires an experienced clinician with knowledge in several different areas. Experienced vestibular physiotherapists who have orthopaedic qualifications are ideal professionals for assessing cervicogenic dizziness. Training in both orthopaedics and vestibular rehabilitation allows the connections between dizziness and neck issues to be much more easily recognized and understood.

A vestibular/orthopaedic physiotherapy assessment will:

  • take a full detailed history of your dizziness and your neck complaints
  • screen for risk factors that can lead to cervicogenic dizziness
  • perform neurological tests of your central nervous system
  • perform a manual physical exam of your neck, specifically testing range, strength, joint integrity and stability
  • perform tests of your peripheral vestibular system

Some experts suggest that one of the best ways to determine if you have cervicogenic dizziness is to receive a series of treatments for the neck and if your dizziness improves, then it’s likely that you have CGD.

 

Treatment for cervicogenic dizziness

Effective treatment for neck-related dizziness relies on a proper diagnosis, as different causes means different cures. Here are some of the more common methods used to help recover from cervicogenic dizziness.

Identifying postural issues and correcting them

Poor posture is an issue with most people, therefore a common area that is addressed with cervicogenic dizziness of all types. Postural imbalances can put unwanted pressure on joints and nerves which disrupt normal communication between the neck and head. Corrections to seated posture while working or using the computer is helpful. It is also recommended to avoid the typical forward head posture that is related to long periods of time using smartphones or gaming.

Orthopaedic Physiotherapy

A skilled physiotherapist with experience treating neck impairments will utilize many tools. This can include:

  • manual therapy to mobilize still neck joints
  • the use of heat on the neck and shoulders followed by stretching exercises of the neck (including postural correction exercises such as chin tucks)
  • retraining neck proprioception (specific exercises to help the neck joints sense position and motion more accurately)
  • strengthening neck muscles and improving core stability of the shoulder, neck, head complex.

CAUTION: there are risks applying neck joint spinal manipulations to patients who have cervicogenic dizziness. There is a chance of worsening symptoms and possibly more severe adverse outcomes. It is advised to use spinal manipulations with great care if this method is considered as a part of the treatment plan.

Acupuncture and dry needling

This can help with reducing symptoms of chronic pain as well as reducing muscle tone and spasm.

Medication

If there is inflammation present, then NSAIDs (non steroidal anti-inflammatory drugs) may be helpful in reducing the acute symptoms and kick-start the recovery process.

In cases of increased muscle tone or spasm, muscle relaxants may be prescribed which can help temporarily reduce symptoms but won’t address the root cause of the dizziness.

Vestibular rehabilitation

This is an area of treatment typically involving supervision by a vestibular physiotherapist. Exercises are specifically prescribed that compensate for the function of your head’s motion sensing system over time with the goal of permanently improving stability. Learn more about how vestibular rehabilitation works here.

Surgery

In rare cases where there are significant issues including the compression of nerves and arteries, surgical procedures can attempt to remove blockages and relieve pressure. This is considered a last resort option as the majority of cervicogenic cases are not this severe and improve with more conservative treatment.

Anxiety Management

Anxiety is a common side effect of many chronic symptoms or conditions where the causes are not clear. With cervical vertigo, anxiety can actually slow your recovery by causing neck muscles to tighten up even more and by over-stimulating and confusing your vestibular system creating more waves of dizziness.

 

Will cervicogenic dizziness go away?

Cervicogenic dizziness is considered a milder condition compared to other dizziness disorders, therefore most patients with this issue has less overall disability. In the majority of cases, appropriate treatment can be extremely effective and recovery is often complete and long-lasting.

However depending on the underlying causes, some cases can become chronic and can result in repeated relapses. Some of these factors include:

 

Cervicogenic Dizziness Treatment Near Me

Cornerstone Physiotherapy has experts in the assessment and treatment of cervicogenic dizziness / cervical vertigo. Our vestibular physiotherapists are also highly qualified orthopaedic physiotherapists who can assess both the cervical spine and vestibular system to help ensure your recovery is optimized. We have dizziness clinics in Toronto, North York, Markham and Burlington. Contact us today and get better, faster.

Click here to learn more about our services.

 


References

1.  Knapstad MK, Nordahl SHG, Goplen FK. Clinical characteristics in patients with cervicogenic dizziness: A systematic review. Health Sci Rep. 2019;2(9):e134.

2.  Li Y, Peng B. Pathogenesis, diagnosis, and treatment of cervical vertigo. Pain Physician. 2015;18(4):E583-595.

3.  Alqahtani MM, Kashoo FZ. Physical therapy in cervicogenic dizziness. Saudi J Health Sci. 2020;9(1):1-6.

4.  Sung YH. Upper cervical spine dysfunction and dizziness. J Exerc Rehabil. 2020;16(5):385-391.

5.  Reid SA, Rivett DA. Manual therapy treatment of cervicogenic dizziness: a systematic review. Man Ther. 2005;10(1):4–13.

6.  Yaseen K, Hendrick P, Ismail A, Felemban M, Alshehri MA. The effectiveness of manual therapy in treating cervicogenic dizziness: a systematic review. J Phys Ther Sci. 2018;30(1):96–102.

7.  Brandt T, Huppert D. A new type of cervical vertigo: Head motion-induced spells in acute neck pain. Neurology 2016;86(10):974–975.

8.  Peng B. Cervical vertigo: historical reviews and advances. World Neurosurg 2018;109:347–350.

9.  Bose K (1999) The efficacy and safety of eperisone in patients with cervical spondylosis: results of a randomized, double-blind, placebo-controlled trial. Methods Find Exp Clin Pharmacol 21:209–213

10.  Alexander S. Reiley*, Frank M. Vickory, Sarah E. Funderburg, Rachel A. Cesario and Richard A. Clendaniel Reiley et al. How to diagnose cervicogenic dizziness Archives of Physiotherapy (2017) 7:12

About the author

Joon Nah

Co-founder, Physiotherapist Learn More about Joon Nah

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