Cervical Vertigo: Treating Dizziness from Neck Pain

Cervical vertigo is a sensation of spinning related to the spine in the neck (cervical spine). We do not know the incidence or prevalence of cervical vertigo because doctors disagree about its symptoms and diagnosis. Neck pain is extremely common, as is vertigo, so the two conditions may occur together by simple chance. However, cervical vertigo or cervical dizziness requires that the dizziness is caused by an issue in cervical spine.

Causes of Cervical Vertigo

The precise cause of cervical vertigo is unknown. Several conditions and events have been linked to cervical vertigo including whiplash injury, head and neck trauma, cervical disc degeneration, cervical disc herniation, cervical muscle spasms, tumors, infections, arterial dissections, and infarction.

Several hypotheses have been developed to explain the cause of cervical vertigo including:

Somatosensory input hypothesis
Triggered migraine hypothesis
Trigeminal hypothesis not invoking migraine
Neurovascular hypothesis
Carotid sinus syndrome hypothesis
Syncope-mediated hypothesis

In short, scientists do not know what causes cervical vertigo. In fact, some argue whether cervical vertigo is a valid diagnosis. Nonetheless, those who experience neck pain and vertigo deserve treatment for these debilitating conditions.

Symptoms of Cervical Vertigo

The symptoms of cervical vertigo vary from person to person. Most describe a feeling of spinning or feeling dizzy. The feeling has also been described as that of floating or as if the head was moving separately from the body. Not surprisingly, people with cervical vertigo sometimes have trouble walking or standing—the sensations of movement do not match what the body is doing. Eye movements are tied to the vestibular system—so people may have nystagmus (rapid, back and forth eye movements). The whole experience is uncomfortable and disconcerting, and may be associated with headache nausea, and vomiting.

Importantly, the dizziness needs to be coupled with some sort of neck pain or neck movement. Indeed, certain neck movements bring about the dizziness or vertigo. On the other hand, if dizziness ever occurs without neck pain or neck movement, the person likely does not have cervical vertigo.

Diagnosing Cervical Vertigo

Cervical vertigo can be difficult to diagnose. Simply having both cervical issues and vertigo is not enough to make this diagnosis. Your physician will take a careful medical history and perform a physical examination, including a neurological examination focusing on the cranial nerves. Your physician may perform some evocative maneuvers such as the Dix-Hallpike test. Depending on the results of the history and physical examination, your physician my order one or more studies including an MRI, MR angiography, CT scan, CT angiography, ultrasound of the blood vessels in the neck, or vestibular testing. In many ways, the diagnosis of cervical vertigo is a diagnosis of exclusion. In other words, other causes of vertigo should be investigated and ruled out.

Treatment Options for Cervical Vertigo

The key to successful treatment for cervical vertigo is to identify the cause and address it directly. If the cervical vertigo is caused by cervical disc degeneration, then treatments for cervical disc degeneration are the main course of action. If the cause is whiplash injury, then NSAIDs, muscle relaxants, physical therapy, and chiropractic may be useful. Problems with blood vessels may need to be treated by a vascular surgeon or cardiologist.

Just as there is no one cause of cervical vertigo, there is no one course of treatment for cervical vertigo.

Prevention of Cervical Vertigo

Unfortunately, there is no way to completely prevent cervical vertigo. You can reduce your chances of developing cervical vertigo by regularly perform exercises that strengthen the neck muscles. Neck flexibility and mobility are also important preventative measure. Maintain good posture while standing, walking, and sitting. Treat any risk factors for atherosclerosis you may have such as obesity, abnormal cholesterol levels, high blood pressure, diabetes, sedentary lifestyle, and smoking.

When to See a Doctor

Most injuries involving the cervical spine (neck) have the potential to be serious, even deadly. If your symptoms started immediately after a car accident, fall, or other trauma, seek medical attention immediately. Do not move your neck in case there has been a vertebral fracture (this is why emergency personnel put neck braces on injured people—to stabilize the cervical spine).

In many cases, the symptoms of cervical vertigo start days to weeks after the initial neck injury or the person can’t recall a neck injury at all. In these cases, emergency medical attention is usually not necessary. However, if you experience a fever, in both arms, arm weakness, or problems with urination or with bowel movements, seek medical help right way as these could be signs of a serious condition.

Conclusion

Cervical vertigo can be frustrating for patients and physicians. Research into the causes, diagnosis and treatments for cervical vertigo is sorely needed. Until this research is performed, however, patients must take it upon themselves to seek out the correct diagnosis and treatment. Often this means seeing more than one physician. A good place to start is with a neurologist or neurosurgeon. Ask the tough questions including: