Cervicogenic Vertigo: Causes and Best Treatment Options

What is Cervicogenic Vertigo?

Vertigo and dizziness are often used interchangeably, but these debilitating physical conditions are slightly different.

Vertigo is a type of dizziness, but not all dizziness is Vertigo.

It’s estimated that 40 percent of U.S. adults will experience Vertigo at least once in their lifetime, with women slightly more likely to get it than men.

There are different types of Vertigo.

The most common types include Central Vertigo (sometimes seen after trauma) and Peripheral Vertigo (the most common type being BPPV – or Benign Paroxysmal Positional Vertigo).

In most instances, Vertigo is caused by a malfunction within the inner ear.

Improper information is relayed to the brain, causing it to perceive that the body is tipping or moving when it is not.

Vertigo can also arise as a viral symptom or other conditions like diabetes or a stroke.

This neck pain is usually located in the upper portion of the neck near the suboccipital region.

Causes of Cervicogenic Vertigo

The exact cause of Cervicogenic Vertigo is unknown, but several theories have been proposed over the years regarding the mechanisms behind this condition.

Yongchao et al. have compiled four of the most popular proposed pathophysiologies for Cervicogenic Vertigo.

1. Barre-Lieou Syndrome

This hypothesis proposes that incorrect input from the nerves in the cervical spine could cause vasoconstriction, leading to less blood flow to areas of the inner ear.

The lack of blood flow then leads to symptoms of Vertigo.

2. Proprioceptive Cervical Vertigo

In this proposed pathophysiology, damage to the joint receptors of the upper cervical spine sends invalid information to the Vestibular nuclei of the brainstem, resulting in Vertigo.

Traumatic injuries like car accidents and whiplash injuries often result in this proprioceptive disorder.

3. Rotational Vertebral Artery Vertigo

This proposed hypothesis states that rotation of the head can cause occlusion (blockage) of the vertebral artery that travels up through the cervical vertebrae.

The lack of blood flow results in symptoms of Vertigo.

4. Migraine-Associated Cervicogenic Vertigo

Neck pain and Vertigo symptoms are often present in conjunction with migraine pain.

It has been proposed that the Cervical Vertigo symptoms are a product of migraine pain.

Recent Developments

The controversial nature of the mechanism of this disorder has led to many studies and debates.

A study performed by Thompson-Harvey et al. investigated the symptoms reported by patients with Cervicogenic Vertigo and compared them to the symptoms reported by those suffering from migraines and other types of Vertigo.

They found a significant overlap in the reported symptoms of Cervical Vertigo and migraines, further lending weight to the theory that Cervicogenic Vertigo may be a subgroup of migraines.

It can often be seen in people who have been in motor vehicle accidents or other traumatic incidents involving the head’s whiplash action, as Yongchao et al. note in their paper.

Common Symptoms of Cervicogenic Vertigo

Cervicogenic Vertigo is a form of dizziness that is related to pain in the neck.

Generally, the neck pain is located at the top of the neck under the occipital region.

This area houses many essential muscles, including the insertion points of the trapezius, levator scapulae, and the suboccipital muscle group.

The location of the C1 and C2 cervical vertebrae also plays a significant role in rotation and lateral flexion of the head and neck.

Cervicogenic Vertigo is a diagnosis by exclusion, meaning that someone is suffering from Vertigo and neck pain.

It also does not have the symptoms and positive tests that classify it as a different type of Vertigo or a cervical spine condition.

Patients with this disorder will often present with pain in the upper part of the neck and tight muscles in the surrounding area.

Many experience a reduction in the range of motion of the neck.

Additionally, many patients will also complain of ancillary migraine symptoms.

Evaluating Cervicogenic Vertigo

The standard orthopedic test for Vertigo is called the Dix-Hallpike Maneuver.

This test involves a series of head movements while the patient lies back quickly.

This motion will exacerbate the Vertigo symptoms if the cause is related to crystals in the inner ear.

If this test is positive, Cervicogenic Vertigo can be ruled out.

Additionally, if Vertigo is present but neck pain is not, then Cervicogenic Vertigo can be ruled out as the diagnosis.

In addition to presenting with neck pain and Vertigo, patients may have hypertonic (tight) neck muscles.

The cervical range of motion in these individuals tends to be limited.

It is not uncommon to experience headache pain in conjunction with this condition.

Diagnostic imaging can be performed to identify further the underlying cause of the neck pain and Vertigo.

In the case of Rotational Vertebral Artery Vertigo, MRA and CTA imaging can help determine if there is a blockage in the artery and can assist in diagnosing the level of arterial obstruction and resultant restriction in blood flow.

The Best Treatment Options for Cervicogenic Vertigo

Treatments for this condition can vary depending on the baseline structures involved in causing the pain and Vertigo.

A 2021 study from China suggests a multi-disciplinary approach to treatment was effective in diagnosing and treating Vertigo.

This integration of disciplines resulted in heightened patient satisfaction, accuracy in diagnosis and treatment, and reduced costs.

These findings are aligned with the emerging homogeneous approach to diagnosing and treatment of Vertigo and dizziness.

Chiropractic care is an integral component of this integrated approach.

Certain types of cervical mobilizations, such as Sustained Natural Apophyseal Glide (SNAG) exercises, have also shown promising results in reducing the severity of dizziness.

In some rare cases, decompressive surgeries provide relief for those suffering from Cervicogenic Vertigo.