Cervicogenic Dizziness, Cervical Vertigo,

What is Cervicogenic Dizziness?

Physiologically, cervical dizziness is explained by the presence of connecting fibers between the somatosensory system of the cervical spine and the vestibular nuclei.  Through these fibers, afferent somatosensory information from the cervical spine can alter the spontaneous firing rates and synchrony of firing among neurons in the vestibular nuclei.

When the somatosensory influence turns out to be a major influencing factor compared to the otolith, semicircular and optical stimuli, the symptoms can be called cervicogenic dizziness.  When the compensation fails from these systems, a vestibular syndrome can occur. The symptoms are usually described as dizziness, lightheadedness, unsteadiness or drunkeness.  True vertigo is rare and typically not a symptom of cervical origin. 

Overall, we can consider these patients to have postural instability and altered head on neck awareness.  The practical consequences to the patient may be dizziness in the short term and imbalance and falls in the long term.  

How do you diagnose Cervicogenic Dizziness?

Symptom provocation is initiated following active or passive neck torsion, typically in a cervical extension or rotation manner. Cervicogenic Dizziness has a different nature and behavior compared to benign paroxysmal positioning vertigo (BPPV) and vertebral-basilar insufficiency (VBI) and it is generally not associated with neurological signs and symptoms.

Several reasons have been described for altered sensorimotor input from the cervical spine.  These usually include acute or chronic neck pain, stiffness and trauma.  Trauma is typically following a fall, whiplash-associated disorder and/or concussion.  Other reasons can be due to accompanying decreased mobility and cervical muscular tone secondary to a peripheral dysfunction.  Due to these factors, cervical dizziness can be described as a single entity or double entity condition.

How do you treat Cervicogenic Dizziness?

Non-invasive cervicothoracic, orofascial and/or shoulder girdle treatment is the best recommendation for initial management of cervicogenic dizziness.  Statistically relevant improvements from manual therapy and exercise in the immediate, short-term and long-term has been found in clinical research to decrease frequency of dizziness, intensity of dizziness, intensity of pain and positive changes on functional outcome measures.  Systematic reviews over the past 15 years have consistently concluded positive changes from joint mobilization and/or manipulation.

Improving neck mobility, decrease viscosity and stiffness, and dampening pain is the first course of action of treatment.  Secondarily, improving eye–head kinematics and gaze accuracy by voluntarily increasing head movement amplitudes and head contributions to gaze saccades may lessen symptoms, improve stability, and reduce falls (Johnston et al 2017)

The improvement of symptoms can be attributed to restoration of cervical mobility and motor control with head on neck orientation.  Since two-thirds of extra cranial vestibular signals are from the cervical spine, achieving balance of proprioceptive and nociceptive input to the central nervous system from the joints and muscle spindles is key management.  This appears to achieve balance in afferent input from multiple systems to the vestibular nuclei that aid in the complex nature of postural control.  Therefore, initially, the disappearance of some of these symptoms is related to changes in neural activity in the vestibular nucleus from changes in the afferent information from the cervical spine.

Do patients with Cervicogenic Dizziness get better?

Patients generally have a very good prognosis, especially if simply a single entity sub-diagnosis.  A double entity sub-diagnosis will require further assessment and treatment procedures to see response in symptoms to then provide the prognosis.  We usually can provide a more detailed analysis after a few sessions to see how the patient responds to multiple therapeutic approaches.


You can learn more about the screening and treatment process of Cervicogenic Dizzinesss through Integrative Clinical Concepts, where the author and his wife, a Vestibular Specialist, teach a 2-day course.  Pertinent to this blog post, the first day provides the most up-to-date evidence review from multiple disciplines to diagnose through the “Optimal Sequence Algorithm” to assist in ruling out disorders and ruling in cervical spine, including determining if single or double entity exists.  

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 prices and discounts.

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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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