What is nautical vertigo?

Vertigo is a sense of movement or rotation of the patient’s own or an external object.

When most people think vertigo, the most common diagnosis is benign paroxysmal positional vertigo (BPPV). This is long for BPPV and the same condition as when people think of crystals being out of place.

Most patients with BPPV report vertigo-like episodes when lying down, extending their head or neck, sitting up from a supine position, and bending over. 

Another type of vertigo is nautical vertigo.

Nautical vertigo is defined as a sensory illusion reminding of movements experienced on board a ship in waves. It is not nearly as common and quite frankly, very limited information is out on this type of vertigo.

With that said, many patients may experience nautical vertigo instead of the typical symptoms of BPPV even though BPPV is much more prevalent.

In fact, an observational study in 2013 found nautical vertigo and dizziness are more common than rotatory vertigo in patients with chronic BPPV.

This could be due to individuals who suffer from vertigo can also have neck pain, headache, widespread pain, fatigue, visual disturbances, cognitive dysfunctions, nausea, and tinnitus. The combination of several symptoms, especially if chronic, can present differently.

The treatment for this type of vertigo does not always respond favorably to canalith repositioning procedures. Nautical vertigo will need more than cervical therapy too.

Individuals will most likely need more vestibular rehabilitation, sensorimotor training and cervical spine treatment as a more comprehensive approach. This is part of our Physio Blend for Cervicogenic Dizziness Treatment. Therefore, it can help more than those with just Cervicogenic Dizziness but those too with nautical vertigo.

CERVICOGENIC DIZZINESS COURSES AND CERVICAL VERTIGO COURSES

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 entire weekend includes the most up-to-date evidence review from multiple disciplines to diagnose through the “Optimal Sequence Algorithm” and treat through the “Physio Blend”.

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.

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

Danielle N. Vaughan, PT, DPT, Vestibular Specialist

3 factors that the vestibular therapist should know about BPPV and stroke.

During the differential diagnosis of a patient with vertigo or dizziness, it is pertinent that the clinician determine if the symptoms are benign / non-benign or central / peripheral.

This is our red light or green light system to treat or refer. This is by far the most important decision that comes out of a clinical evaluation and is especially important with neurological symptoms.

The most common benign cause of vertigo is benign paroxysmal positional vertigo (BPPV). There are specific subjective and objective findings that are crucial to ruling in BPPV in the dizzy patient.

A physical therapist trained in vestibular rehabilitation is well aware of these findings and do a splendid job at helping people! We are actually very good at differential diagnosis and use the latest research to help refine our clinical exam!

In some instances, patients who are having dizzy/vertigo symptoms seek out help from physical therapists with thought they are having BPPV but instead it is an early sign for a stroke. Early diagnosis and intervention are crucial for successful treatment in patients with acute ischemic stroke because prompt thrombolytic treatment improves outcomes. We also do not want to propel a spontaneous dissection through a mechanical input, such as with manual therapy, Dix-Hallpike testing or even range of motion.

In fact, ischemic changes affecting the vestibular artery in patients with BPPV could precede a full-blown ischemic stroke. These ischemic changes affecting the vertebrobasilar system could initially produce vestibular symptoms, such as BPPV. 

Here are a three factors for the vestibular therapist to know about BPPV and stroke:

1. The vestibular organs are vulnerable to ischemic obstruction. This is due to the “small creek” that finally lead to the organs from the anterior vestibular artery, which as we know, originate initially from the vertebral-basilar artery. Therefore, a disturbance of adequate hemodynamics to this region could indicate a disruption more proximal, such as in the vertebral-basilar artery.

2. There are common risk factors associated with both BPPV and ischemic stroke. These can include osteoporosis, smoking, alcohol consumption, anxiety, cardiovascular disease and diabetes. Conditions such as obesity, cardiovascular disease, and diabetes are chronic diseases and related to stroke onset. Therefore, a correlation can be made that BPPV increases the risk of ischemic stroke.

3. BPPV is recurrent and can lead to lifestyle changes. One lifestyle change can be physical inactivity. Physical inactivity following BPPV might increase the risk of an ischemic stroke. A sedentary lifestyle due to avoidance of activities from fear or provocation of vertigo/dizzy symptoms can occur in these patients over time. Our goal is to educate our patients to stay active with proper recommendations based off of the patient’s presentation. Our goal too is to get them better so they do not have impairments!

These are just 3 factors that we believe a vestibular therapist should be aware concerning ischemic stroke while treating a dizzy patient. Having this knowledge helps us go beyond the thinking of pathophysiology of cupulolithiasis and canalolithiasis. These factors can lead to knowledge of not only signs and symptoms associated with non-mechanical and mechanical causes of dizziness, but also education for our patients for the long term, especially for those with recurrent vertigo.

CERVICOGENIC DIZZINESS COURSES AND CERVICAL VERTIGO COURSES

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 entire weekend includes the most up-to-date evidence review from multiple disciplines to diagnose through the “Optimal Sequence Algorithm” and treat through the “Physio Blend”. 

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.

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

5 symptoms of Cervicogenic Dizziness

There are a range of symptoms and variety of potential descriptions of cervicogenic dizziness. Cervicogenic Dizziness symptoms can vary from one person to another and still carries the weight of controversy.

The description of dizziness, including a sensation of spinning and/or dysequilibrium is common (Krabak et al 2000, Kalberg 1996).  It has even been described generally as dizziness that may be associated with headache, cervical pain, nausea, cold sweats and/or nonspecific complaints (Morinaka 2006).

With that said, the following are the top 5 symptoms of Cervicogenic Dizziness.

1. Lightheadiness
2. Drunkenness
3. Unsteadiness
4. Feeling of imbalance
5. Room spinning

It is highly recommended to exclude other sources of dizziness prior to making a diagnosis of cervical origin. We recommend using the Optimal Sequence Algorithm, a detailed subjective and objective screening process.

There are some fine details in symptom and presentation characteristics between several types of dizziness. The differential diagnosis can mean a difference between referring out or greenlight to treat in an outpatient setting.

If benign disorders of the dizziness are found, then the patient could have a double entity, which is both a vestibular disorder and cervical disorder. That is why the patient’s symptoms may vary or change between several of the descriptors above.

CERVICOGENIC DIZZINESS COURSES AND CERVICAL VERTIGO COURSES

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 entire weekend includes the most up-to-date evidence review from multiple disciplines to diagnose through the “Optimal Sequence Algorithm” and treat through the “Physio Blend”. 

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.

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

Can improving cervical lordosis help with Cervicogenic Dizziness?

Cervicogenic dizziness has been described in the medical literature to be caused by functional problem of the cervical spine associated with postural alignment, proprioception and range of motion. Although cervical dizziness is controversial, we have large randomized controlled trials and systematic reviews saying that manual therapy and exercise can help with dizziness frequency, intensity and duration.

However, until two chiropractic pieces have arisen in the last few years, we didn’t know if an improvement in cervical lordosis can be linked to improvement in neck dizziness. I find these article interesting on several accounts, but mostly due to a measure of actual cervical lordosis that physical therapists do not have the capability nor training to examine. Let’s explore more.

The first trial comes from Moustafa et al in 2017 entitled, “The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: a 1-year randomized controlled study”. The authors found a statistically significant differences for all of the measured variables of dizziness impairments between groups, including an improvement in cervical lordosis.

The authors hypothesized that

it was the loss of cervical lordosis that was causative for the dizziness symptoms since the comparison group had only temporary symptomatic relief that was lost at the 1 year follow-up

The second study comes from 2020 case report. Dr. Gerstin and colleagues presented a case entitled, “The treatment of dizziness by improving cervical lordosis: a Chiropractic BioPhysics case report”. This case demonstrates the relief of dizziness by the improvement in cervical lordosis in a mid-aged female. There was an approximate 20° lordosis increase achieved over the duration of one year after 115 in-office treatments.

The authors concluded, “

Cervical hypolordosis may be an under-diagnosed cause of idiopathic dizziness in some patients.

Just two studies linking dizziness improvement alongside lordotic posture is not groundbreaking science, but does show a correlation between dizziness and the cervical spine. Also, it answers our blog question that yes, I would say cervical lordosis improvement can help with Cervicogenic Dizziness.

The one thing I want to send out to the readers is that the symptomology of dizziness, lightheadiness and unsteadiness can improve much quicker than 1 year (the final duration in these articles) but it does take time for reversal of the lordotic curve. Therefore, I would still suggest you can get quick relief with appropriate manual therapy and exercise techniques if the diagnosis is correct of cervical reason for the dizziness symptoms.

Without getting into too much details for the readers, the pathophysiology of loss of lordosis is described by the following statement that I use in my teachings: The hypolordosis in mid-cervcial spine will eventually lead to concomitant upper cervical spine extension posture to compensate and assist in horizontal gaze. Therefore, the treatment to the upper cervical spine to improve mobility and flexion will help symptoms in the short term, but ultimately for long term control, addressing the mid-cervical spine to aid in improving cervical lordosis is absolutely necessary.

I applaud these authors for putting this information out there and continue to advance the diagnosis and treatment for these disorders!

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 second day provides the most up-to-date evidence review from multiple disciplines to treat through the “Physio Blend”, a comprehensive approach to treating neck pain and dizziness / vertigo symptoms.

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.

Sign up for more emails on this topic by clicking here

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

Can Craniosacral Osteopathy help Dizziness?

As consistent authors, teachers and clinicians that diagnose and manage dizziness disorders, especially from the cervical spine, we always research the newest information out there to help persons with these conditions.

I found a recent journal article out of Turkey by Atay et al examining the effect of craniosacral osteopathy on dizziness and balance in individuals who have peripheral vestibular pathology.

The participants who were diagnosed with chronic vertigo were divided into two groups:

 

1. Cranial osteopathy treatment group

• • Impairments of cranial, cervical, thoracocervical, and facial dysfunctions were determined by and treated with muscle energy (postisometric relaxation), fascial stretching against tension, and craniosacral treatment methods.
  • Prescribed dosage: Total of 6 sessions (once/week for 60 minutes)

2. Dimenhydrinate 

• • This medicine is an antihistamine over the counter drug intended to treat motion sickness, dizziness, vertigo and nausea.
  • Prescribed dosage taken twice/day over 6 weeks

The visual analog scale, BERG balance test and Activities-Specific Balance Confidence scale were used to define success of the treatment(s) and to analyze within-group changes.

Here are the author’s conclusion of comparing the two groups:

Craniosacral osteopathy resulted in greater improvements in terms of dizziness and balance compared to medical treatment in individuals with chronic peripheral vestibular pathology.

Craniosacral osteopathy is an effective treatment choice in individuals who have chronic peripheral vestibular pathology.

In individuals who have resistant and chronic vestibular pathology, craniosacral osteopathy should be evaluated among the treatment choices.

Our Impression of the study

We would say generally speaking, this study is good news!  It adds to the plethora of work that shows somatic treatment of the cervical spine and facial structures can assist in improving symptoms of dizziness and vertigo.

Manual Therapy to the Neck for Cervicogenic Dizziness Treatment

This is the basis behind the larger diagnosis of Cervicogenic Dizziness, even though this term was not specifically used in the study.  This study would go nicely inside our e-book, “Why the Vestibular Therapist should learn Cervical Manual Therapy” – which is a nice and brief overview of the connections between the somatosensory, visual and vestibular systems.

Even though Osteopathic medicine has been around since 1874, there hasn’t been a great deal of actual research studies demonstrating its effects for dizziness and vertigo.  Majority of our data that we teach comes from the chiropractic and physical therapy professions, but this doesn’t mean that its absence in the literature means its not effective.

Overall, this isn’t a strong study by any means. Both groups combined to n=24 and comparison of a “mechanical” treatment against a “chemical” treatment (Dimenhydrinate) isn’t mighty to determine if craniosacral osteopathy is superior to vestibular therapy or any other type of manual therapy. 

However, if you’re a physician who is reading this, it is nice to consider your go-to medications aren’t working well, then a manual-based or even vestibular-based practitioner could give your patients superior relief and quality of life.  

If you’re a vestibular therapist reading this, I would again consider learning techniques to the cervical spine and/or skull & face in an organized manner to provide more strategies in improving pain and function.  We provide this data from over 300 references in the literature and our own clinical experience through our Physio Blend to ultimately give you the best of the best to treat individuals with dizziness and/vertigo from a manual standpoint.

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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 second day provides the most up-to-date evidence review from multiple disciplines to treat through the “Physio Blend”, a comprehensive approach to treating neck pain and dizziness / vertigo symptoms.

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.

Sign up for more emails on this topic by clicking here

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

 

Can Cupping Therapy help Dizziness?

Cupping therapy can be described as a technique that uses cups placed over the skin to create negative pressure through suction.  It has been in use all over the world for centuries for many musculoskeletal and some non-musculoskeletal conditions.  The treatment approach has created more buzz in the Physio world for the past few years for musculoskeletal conditions, mostly pain.

I believe the pictures of Olympic swimmer, Michael Phelps, in 2016 games was the reason the modality was brought to the attention of the most of the western world.   Therefore, it struck a chord with the sport and active crowd!

There are two types of cupping methods, dry and wet. Dry cupping is noninvasive with no bloodletting. Wet cupping is invasive and includes bloodletting.  The current western approach by physios / chiropractors and massage therapists use the dry cupping method.

Our profession has then created many variations of cupping approaches.  Some clinicians leave them in place for a period of time with the patient still.  Some clinicians move the cups over the skin themselves through different planes.  Some clinicians even leave them in place for a period of time on patients but have the patient move in a therapeutic manner.

The question that I have never encountered before is the title of this blog: “Can Cupping help Dizziness?”

To answer that question from the medical research, I take the reader to a case report by Almusleh and Ansari in 2020 entitled “Integrating Cupping Therapy in the Management of Sudden Sensorineural Hearing Loss: a Case Report” in the journal, Cureus.  You can access it free here. 

I find it interesting to read literature outside our profession as it broadens the mindset of what others can do.  It is the same reason I get any PT student to observe local chiropractors, acupuncturists, podiatrists, running shoe store owners, etc as we tend to get stuck in our own ways that exercise fixes everything!

If you read the title, you will realize that the authors were mainly writing about the effects of wet cupping for sudden sensorineural hearing loss that failed conventional medical treatment, but within the report, you will see this statement on dizziness changes:

DHI {Dizziness Handicap Inventory} score was improved from an initial 52 score to 0 (no handicap at all)

And this conclusion:

In our case, WCT {wet cupping therapy} improved the feeling of fullness after the first session and improved hearing loss, tinnitus, and dizziness after the completion of the WCT treatment regime (12 weeks).

We don’t recommend every patient with dizziness to get wet cupping from the report by any means!  However, I think it does show a link between many symptoms: dizziness, hearing loss, tinnitus and pain.  It also shows a manual therapy approach can be helpful for these conditions, including dizziness.

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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 second day provides the most up-to-date evidence review from multiple disciplines to treat through the “Physio Blend”, a comprehensive approach to treating neck pain and dizziness / vertigo symptoms.

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.

Sign up for more emails on this topic by clicking here

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

Is muscle thickness different in persons with cervical vertigo?

Is muscle thickness different in persons with cervical vertigo?

Out of Iran and part of PhD work, Dr. Ronak Zagar, and colleagues in a 2020 study examined this just question.

The study examined muscle thickness of both the anterior and posterior cervical muscles using ultrasound between persons diagnosed with cervical vertigo and compared the results to healthy controls.  Figure 1 from the study is shown below:

Ronak Zargar Talebi et al. Evaluation of cervical spine muscles thickness in patients with cervical vertigo and healthy controls through ultrasonographyJ Phys Ther Sci. 2020 Jul; 32(7): 439–443.

The cervical flexors (anterior muscles) studied were:

1. Sternocleidomastoid
2. Longus Colli
3. Longus Capitis

The cervical extensors (posterior muscles) studied were:

1. Rectus Capitis Posterior Major bil
2. Obliquees Capitis Inferior bil

The main findings of the study were:

The thickness of extensor muscles was not significantly different between the patients with cervical vertigo and healthy participants.

The Longus Colli thickness was higher in the patients with cervical vertigo than healthy subjects.

How do the authors interpret this research?

The authors hypothesized that the higher thickness of Longus Colli may a compensatory mechanism in the patients with cervical vertigo.  

They go on to write,

Due to the small number of the literature in the field of RUSI, clinical interpretation of the findings is difficult and more studies are required to confirm results of our study, but so far, it can be suggested that the clinicians take into account the findings of this study in the evaluation of patients with cervical vertigo and incorporated the cervical stabilization exercises in the treatment planning for the cervical vertigo.

How do we interpret this research as clinicians?

It is inherently known in the rehabilitation profession that a mis-match exists between the deep and superficial deep cervical flexors and extensors in individuals with vertigo, dizziness, neck pain, whiplash, mTBI and concussion.  The mis-match can vary depending on the plethora of studies performed over the last 20 years, but generally speaking, there is a motor control disturbance placing too much of a demand on the superficial vs deep musculature.

The current study is quite interesting that prior to reading it, I would have hypothesized that the Sternocleidomastoid (SCM) would have higher thickness values.  Instead, the findings are the opposite, with the Longus Colli taking first place.

Overall, I utilize this one study as another puzzle piece for a multi-sensory condition.  This does not change my practice patterns.  I will not stop inhibiting the SCM and aim to activate the Longus Colli more effectively as this works and works well.

This research makes medicine and science interesting and progressive.  I am glad we now have the technology to perform these types of studies in rehabilitation and I look forward to future research by this group or other groups to continue to help others.

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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.

Sign up for more emails on this topic by clicking here

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

Save 60% of time with the shortened Dizziness Handicap Inventory

In any vestibular, neurological or even orthopaedic practice that treats patients with dizziness and vertigo, the use of the Dizziness Handicap Inventory (DHI) is the most popular self-report questionnaire. We have written about this outcome measure for sensorimotor disorders in a previous post to utilize for clinical practice.  You can also access the DHI, and other sensorimotor measures, on our Cervicogenic Dizziness Kit page.

Even though answering 25 questions isn’t the biggest time consuming event for patients and clinicians, it is always nice to do less and get same outcome.  Recently, van Vugt and colleagues in 2020 thought this way too. The authors studied a 10 item questionnaire, entitled shortened version of the Dizziness Handicap Inventory (DHI-S) — initially created by Jacobson & Calder in 1998 — and compared its psychometric properties compared to the gold standard of the DHI.

Here is the main points that come from the article:

• The most used method to measure vestibular symptoms such as vertigo and dizziness is the 25-item Dizziness Handicap Inventory (DHI) questionnaire, but the abbreviated 10-item DHI-S questionnaire is more suitable for daily clinical practice.

• Our findings indicate that the DHI-S questionnaire is a valid, reliable and responsive tool to measure vestibular symptoms in general practice and could prove to be a valuable tool.

Therefore, it is applicable to utilize the DHI-S in clinical practice.  Awesome!

So how does this relate to Cervicogenic Dizziness?

As noted in the title, 60% of the questions are omitted in the shortened version of the DHI.  Unfortunately, the DHI-S is missing 2 out of 3 key questions that Susan Reid & colleagues found in 2017 to screen patients with Cervicogenic Dizziness.

The key questions on the DHI for screening for Cervicogenic Dizziness are:

1. Does looking up increase your problem? (P1)
2. Because of your problem, are you afraid to leave your home without having someone accompany you? (E9)
3. Do quick movements of your head increase your problem? (P11)

The DHI-S does include #2 above, which would usually be answered, “No”, if someone has Cervicogenic Dizziness.  However, #1 and #3 above, which would usually be answered, “Yes”, if someone has Cervicogenic Dizziness, are missing.

Therefore, if you are using the DHI to screen patients and assist in ruling out Cervicogenic Dizziness (such as prior to your physical examination), you will be missing too many data points, at least based on Reid’s 2007 work, from the DHI-S to make an appropriate call.  Also, the items missing in the DHI-S do not show the potential of head on neck awareness as #1 and #3 above ask, again, confirming not a good measure for Cervicogenic Dizziness.

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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.

Sign up for more emails on this topic by clicking here

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

Can the teeth cause dizziness?

Of course anyone reading this blog over the last several years realizes the intent is to rule in and rule out the cervical spine as a driver for the symptoms of dizziness, lightheadiness, drunkenness and unsteadiness.

Therefore, the question, “Can the teeth cause dizziness” is an interesting inquiry and not a common source of dizziness.  However, for anyone treating upper quarter symptoms, it is pertinent to know a few of these outliers.

I would like to initially relay material from a 2019 case report entitled, “Recovering of Dizziness of a Patient with Sinusitis after Root Canal Therapy for Upper Second Molar”.

Here are some of the highlights:

• 26-year-old male had suffered from dizziness in walking and standing.  He had a headache while eating and tilting his head forward.
• The patient consulted internal, cardiac, and neurological and ENT specialists to treat the dizziness but no success.
• Videonystagmography, Cervical MRI normal and brain MRI showed sinusitis.
• The patient sought out dental services.  Without getting into details of the diagnostic and treatment approach, he basically underwent root canal therapy.
• Two months after the intervention, the patient reported a complete recovery of dizziness and sinusitis; pain was reported as 0/10.

Conclusion from Amro et al:

• Sinusitis is a common etiology of dizziness, but sinusitis of odontogenic cause associated with dizziness had not been discussed in literature according to the knowledge of the authors, which is the main finding of this article.
  • This is the main concept I want to relay to our readers too…
• In this case, dizziness was recovered, after the sinusitis had improved, with no major intervention other than root canal therapy
• Recommendations of this study include the evaluation of any dizzy patient must include dental history and examination, to exclude any causes of dental origin.

Anyone who knows us, knows we like case reports and recommend students read these as well to help understand a clinical reasoning process.  I just gave you a short synoposis above, but recommend you read the full text from the journal, Case Reports in Dentistry.  Lucky us, it is open access article and can be found here!

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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.

Sign up for more emails on this topic by clicking here

Authors

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

Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts

Danielle N. Vaughan, PT, DPT, Vestibular Specialist  

Suspecting a patient has VBI? You could recommend this.

The probability of a patient arriving to your outpatient, physical therapy office with symptoms associated with vertebrobasilar insufficiency (VBI) is very, very, very minimal.  VBI is an important diagnosis to consider, as many symptoms can mimic benign peripheral etiologies in our industry.

Most of the data in the physical therapy world on the incidence of VBI is after a manipulation, which is anywhere 1 in 20,000 to 1 in 1 million.  But I’m not talking about iatrogenic causes, but actual spontaneous events, which is what would most likely lead someone to come into your office.

The probability of this non-benign condition is higher if you treat neck pain and even higher if you treat headaches and dizziness.  We know the work by Lucy Thomas especially has shown in chart reviews that dizziness, headaches and balance/postural issues are high impact symptoms of VBI.  Her recent work has confirmed the previous work by Alan Taylor & Roger Kerry from mid-2000s.

As differential diagnosis machines, we need to be to be able to effectively address neuromusculoskeletal conditions.  Clinicians should always have VBI as a small nugget in the back of the head as quite frankly, a central cause of headaches, neck pain or dizziness is not one of which we should back down lightly in our knowledge of differential diagnosis.

Rights Reserved: Harrison N. Vaughan, DPT, FAAOMPT

We have written in the past (here, here, and here) about ruling out vascular sources that leads to these symptoms in the past and even have written about the use of the HINTS examination to assist clinicians in differentiating between central and peripheral causes of dizziness.  There has been a significant spike of power behind simply looking at blood pressure and we know these tools are highly necessary before doing any type of mechanical testing, such as the VBI test.

Another tool that is not spoken much about, but we have in our algorithm to rule out spontaneous disorders, is the use of biomarkers.  The use of biomarkers for differential diagnosis is used for other conditions (such as temperature for a fever) but not spoken of much in the physical therapy world.

The use of blood biomarkers for differential of VBI was spoken of over 20 yrs ago quite but to my readings of the literature in the past decade, I haven’t seen much about it until now.  A recent study in 2020 out of South Korea by Sohn et al brought this information back to life and I want to share with you all.

The authors looked at blood biomarkers to examine differential diagnosis in 2 groups — 1 is central vertigo (CV) and 2 is peripheral vertigo (PV).  We know VBI would be under central vertigo.  The patient also went under full neurology examination including having MRA and CT scan.

Here is what they found:

 Serum NSE and S100β levels are significantly higher in patients with CV, such as occurs with posterior circulation ischemic stroke or vertebrobasilar insufficiency. S100β and NSE may serve as serum biomarkers for differentiating between CV and PV in patients with acute-onset vertigo.

Take home points

First, I take this information as another recommendation I could make to the medical staff to obtain, in addition to full neuro examination including MRA, if I suspect central vertigo through my clinical examination.

Secondly, I take this information as another non-mechanical test (such as prior to cervical ROM and VBI testing) that could be achieved before placing undue stress on the blood vessels that could take a spontaneous dissection to a full dissection.  We all know how this is usual what happens and what has given manipulation such a bad name in the past.  We had a great article we wrote awhile ago about this happening NOT from manipulation, but from cupping and massage.  I think this can help you understand this concept more.

Thirdly, I know we can’t order or have ability to obtain blood biomarkers, nor understand how to read the results professionally.  Therefore, I take this type of study as a physical therapist with confirming the already established Optimal Sequence Algorithm for diagnosing not only Cervicogenic Dizziness, but for Cervical Artery Dysfunction.

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Cervicogenic Dizziness Course

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