Cervicogenic Dizziness

We have all had that patient with vague complaints of “feeling spacy” after they have experienced a whiplash injury from a motor vehicle accident.  Many of them also have experienced a bump on the head, so you have to consider the possibility that they have Benign Paroxysmal Positional Vertigo, but are describing it in an unusual way.  Could their symptoms be the result of an injury to the muscles and nerves in their neck?

Cervicogenic Dizziness (CD) is a controversial diagnosis, but it appears that some patients suffer vestibular type symptoms associated with neck pain, neck tension or torsion. This condition has been referred to as “cervical vertigo”; however rotary vertigo is not a typical complaint in these patients.

More typical complains associated with this condition include:

“I feel like I am floating when I move around.”

“I have a lot of pain in my neck.”

“ I have a lot of headaches.”

“I feel disoriented when I move my head.”

“People say my head is always tilted.”

Furman and Cass (1996) define Cervicogenic Dizziness as “a non-specific sensation of altered orientation in space and disequilibrium originating from abnormal afferent activity from the neck.” The theoretical basis for the specific etiology of CD continues to evolve, but current thinking suggests that CD “results from abnormal input into the vestibular nuclei from the proprioceptors of the upper cervical region” {{1}}[[1]]Wrisley, D., Sparto, P., Whitney, S., Furman, J. (2000). Cervicogenic dizziness: a review of diagnosis and treatment. Journal of Orthopaedic & Sports Physical Therapy 30(12) 755 –766.[[1]]

Cervicogenic dizziness is a diagnosis of exclusion, and these patients typically require a comprehensive vestibular examination to identify or rule out vestibular dysfunction as a source of their complaints. There is no definitive test that can unequivocally identify the cervical spine as the source of a patient’s complaints. Wrisley et al. {{1}}[[1]]Wrisley, D., Sparto, P., Whitney, S., Furman, J. (2000). Cervicogenic dizziness: a review of diagnosis and treatment. Journal of Orthopaedic & Sports Physical Therapy 30(12) 755 –766)[[1]] list three elements required to make the diagnosis of CD: “1. a close temporal relationship between neck pain and symptoms of dizziness, including time of onset and occurence of episodes, 2. previous neck injury or pathology, and 3. elimination of other causes of dizziness.” Risk factors for CD include whiplash injury, cervical disc disease, degenerative arthritis, and repetitive motion stress injury.

 Vestibular Function Tests and Cervicogenic Dizziness

Traditional vestibular evaluation will usually be normal; however, patients with CD may exhibit nystagmus with neck torsion. Some investigators have suggested that neck torsion be accomplished in a head-fixed, body-rotated method to avoid stimulating the labyrinth. Caution should be exercised in these patients when performing the Dix-Hallpike exam, and neck range of motion should be established prior to this test. These patients may benefit from a combination of vestibular rehabilitation and manual therapy. Referral to a Physiatrist or Physical Therapist may be helpful.

 

About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.