Cervicogenic Dizziness, Cervical Vertigo, Neck Pain, Dizziness, Cervical Spine

Benign paroxysmal positional vertigo (BPPV) can be defined as transient, position-induced torsional, vertical, or horizontal nystagmus with vertigo.

What causes BPPV?

The pathology is based on displacement of the otoconia in the semicircular canal (canalolithiasis) or attachment of debris/otoliths to the cupula (cupulolithiasis). It can be a primary issue or secondary issue from other conditions.

Unfortunately, the underlying pathology is often obscure and the “main” reason is not always known – hence, what we call idiopathic. In this case, we call it idiopathic BPPV.

What factors lead up to having this diagnosis?

Considering most cases of BPPV are idiopathic, there are other factors associated with BPPV. Everyone wants to know “why” they have this diagnosis and as healthcare professionals, we can’t always pinpoint one specific reason. But, usually there are several reasons that then “overload” your system and cause a “spill-over” effect —- which means your body can’t compensate any further and you get symptoms.

Here is a list of 18, yes 18, factors associated with BPPV!

  1. Aging

  2. Migraine

  3. Meniere’s Disease

  4. Trauma (such as car accident, concussion, whiplash)

  5. Infection

  6. Vestibular Neuronitis

  7. Idiopathic sudden sensorineural hearing loss

  8. Sleeping habits

  9. Osteoporosis and vitamin D insufficiency

  10. Hyperglycemia and diabetes mellitus

  11. Chronic head and neck pain

  12. Vestibule or semicircular canal pathology

  13. Pigmentation disorders

  14. Estrogen deficiency

  15. Neurological disorders

  16. Auto- immune, inflammatory, or rheumatologic disorders

  17. Familial or genetic predisposition

  18. Allergy

Wow, that’s a lot of factors that could lead to you having BPPV!

What does all of this mean for me if I treat BPPV and even other dizzy/vertigo patients?

Vestibular Therapy to Treat Cervicogenic Dizziness

Basically, this means that the well-rounded treatment is more than just “a manuever”. Yes, we can all knock this out and do a pretty solid job with it!  It is the more “complicated” cases that we aim for and can help the most.

Overall, we recommend getting trained in Vestibular Rehabilitation and Upper Quarter Manual Therapy to fully address these patients.  Also, take the time and training to examine their symptoms and discuss lifestyle factors and other strategies to not only prevent BPPV from having again but overall, address the entire body and give it all to your patients.

How does BPPV relate to Cervicogenic Dizziness?

For this article and our specialization under the realm of Cervicogenic Dizziness from Cervical Arthrogenic and Myofascial pain, I like to address 2 of the 18 points above — numbers 4 and 11.

#4 Trauma (such as car accident, concussion, whiplash)

We consider someone who has had trauma under the realm of “double entity”.  This means that there are at least 2 systems involved (i.e. inner ear and neck pain).  This is more common than generally Cervicogenic Dizziness is identified in the literature and quite frankly, we find some type of neck disturbance in pretty much every single one of these patients.

#11 Chronic head and neck pain

This coincides well with Trauma above but may need more explaining to the patient as there is not one single type of injury.  This is what you can consider to be more of a single entity instead of just BPPV, but coincides in at least 70% of our BPPV patients.  As we discuss in our clinic and courses, we recommend treating BPPV first via canalith repositioning manuevers, but adjunct it with manual therapies and exercises for the neck to fully treat the whole system.


You can learn more about the screening and treatment process of Cervicogenic Dizzinesss through Integrative Clinical Concepts, where the authors (husband–a manual therapist a wife—a vestibular specialist), teach a very unique course combining both the theory and practice of vestibular and manual principles in their 2-day course.  

Pertinent to this blog post, the 2nd day includes the “Physio Blend”, a multi-faceted physiotherapist approach to the management of Cervicogenic Dizziness, which includes addressing the articular and non-articular dysfunctions of the neck; as well as graded exercise, vestibular and sensorimotor approaches. 

If you would like to host a course for your staff (either a vestibular, neuro, sports or ortho clinic), please do not hesitate to contact me at harrisonvaughanpt@gmail.com for more information.

AUTHORS

Harrison N. Vaughan, PT, DPT, OCS, Dip. Osteopracic, FAAOMPT    

Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts

Danielle N. Vaughan, PT, DPT, Vestibular Specialist  

Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts

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