Cervical Vertigo | Dizziness
In this article Ross Hauser, MD discusses the diagnosis and treatment of cervical vertigo and chronic dizziness associated with neck movement.
Doctors know that the diagnosis of cervical vertigo is controversial. At one time it was an over emphasized diagnosis now it is “often overlooked and it seems to combine elements of myth and reality”.1
The controversy surrounding a diagnosis of cervical vertigo stems from the difficulty related to making a correct diagnosis as to its cause and its frequent use in whiplash related injuries.
Dizziness is a growing problem in the aging population
In recent research from December 2015, researchers in Australia discussed the serious problem of dizziness in patients over the age of 50. They noted that dizziness and imbalance are clinically poorly defined terms, which affect more than 30% of people over 65 years of age.
In these people, it is often difficult to define the primary cause of dizziness, as it can stem from cardiovascular, vestibular, psychological, and neuromuscular causes. However, identification of the primary cause is vital in determining the most effective treatment strategy for a patient. 2
New research confirms that dizziness is a growing problem in the aging population with critical health consequences. Simply: Dizziness is one of the most prevalent symptoms in old age and tends to increase with age.
In this research Swedish doctors looked at 675 people aged 75 years old. They gave these people a survey with questions concerning dizziness/imbalance, physical activity level, walking habits, falls efficacy, number of falls, subjective health or general fatigue and medication.
- More women than men reported dizziness/imbalance (40 vs 30 %).
- Persons with dizziness, compared to those without dizziness, less often regularly exercised at a moderate intensity level
- less often took a daily walk
- more often reported general fatigue
- more often had fallen in the previous year
- and had a higher intake of medical drugs
- They also performed worse regarding gait speed, stair climbing and one leg stance.
The unfortunate conclusion of the study was older persons with dizziness are less physically active, have worse lower extremity function, are more often fallers and report lower self-rated health than persons without dizziness.3
Damaged cervical ligaments as a cause of dizziness
Seeking to isolate a true cause of cervical vertigo and dizziness, scientists methodically eliminated the possible causes of vertigo (i.e, whiplash) to focus on degenerative osteoarthritis (cervical spondylosis) as the main culprit. They looked at 583 patients with spondylosis, 379 were found to have vertigo for more than 6 months.
Then investigations were done on these patients to exclude other common vertigo causes. Then the disease severity of these 323 patients, with no obvious cause of vertigo, were compared with the remaining 260 patients. A series of clinical tests were done to exclude vertebral artery occlusion (blockage). No significant disparity in severity of the disease was found between the 2 groups, also a few patients among the former group showed signs of arterial occlusion. therefore cervical spondylosis couldn’t be blamed for the occurrence of vertigo in every patient.
So not every patient who had cervical spondylosis had vertigo, but some did. So the conclusion was cervical spondylosis as cause for some, not all. 4
However, these findings were not in agreement with a more recent study which found that vertigo is associated with advanced degenerative changes in patients with cervical spondylosis.
Vertigo is associated with advanced degenerative changes in patients with cervical spondylosis and loss of blood flow to the brain
In this research, doctors speculated that since vascular risk factors that can lead to artery blockage are common findings in the elderly, cervical spondylosis-which is also common in such age group must be associated. As noted in the research above.
These researchers then set out to investigate the effect of cervical spondylosis on blood flow during cervical rotation and to identify the possible association of vertigo with the decreased blood flow.
The incidence of cervical spondylosis was estimated in patients with and without vertigo. Patients with vertigo proven to have spondylosis were further compared with patients having spondylosis but not complaining of vertigo and patients who neither have spondylosis nor complained of vertigo who served as controls.
What they found was:
“A significantly higher prevalence of cervical spondylosis was found among patients complaining of vertigo than those in non-vertigo group. . .
Furthermore, among patients with cervical spondylosis, patients having vertigo showed significantly more evident degenerative changes. . .
Cervical spondylosis patients with vertigo had statistically significant lower blood flow parameters with contralateral head rotation in the left and right vertebral arteries than cervical spondylosis patients without vertigo and controls.”
They concluded: “In patients with high-grade cervical spondylosis with more extensive osteophyte formation, the decreased blood flow becomes prominent and symptomatic presenting as vertigo.”5
Vertigo associated with other diagnoses
- Barré-Lieou Syndrome, which involves a very wide range of symptoms thought to be due to a dysfunction of the group of nerves called the posterior cervical sympathetic nervous system, located near the vertebrae in the neck;
- Temporomandibular Joint (TMJ) Syndrome, which involves spasms of the chewing muscles, often as a result of clenching the jaw or grinding the teeth, both of which are aggravated by stress;
- Eagle Syndrome, which involves the elongation of the styloid process and stylohyoid ligament calcification, and results in sharp, intermittent pain along the glossopharyngeal nerve, as well as vertigo; and
- Ernest Syndrome, which arises when the stylomandibular ligament of the jaw becomes inflamed and produces feelings of pain in several areas of the head and neck, as well as vertigo.
Vertigo treatment with Prolotherapy
A patient seeking vertigo treatments at the general practitioners’ office may find treatment options depend on the cause of the dizziness, which is determined by an examination of the ears, eye movements and nervous system. Other tests include: a caloric test, in which water at different temperatures is poured into the ear to check the vestibular function in the brain; a neck x-ray to check for cervical spondylitis; and/or a CT scan or MRI to rule out a tumor pressing on the brain.
The results would determine the treatment approach. For example, if Ménière’s Disease is suspected as the cause of the vertigo, a low-salt diet may be recommended. If, on the other hand, an infection is
suspected, antibiotics will be prescribed. If no apparent cause is found, medications such as antihistamines, anticholinergics (to prevent nausea, vomiting and motion sickness) or benzodiazepines (to relieve anxiety) may be prescribed to help stabilize the structures in the inner ear. Vestibular rehabilitation, or balancing exercises, may also be recommended. For severe, disabling cases that do not respond to medication and exercise, surgery may be suggested.
Prolotherapy is an injection technique that stimulates repair of unstable, torn, or damaged ligaments. When ligaments are unstable, they allow for excessive movement of the bones, which can then restrict
blood flow to the brain, pinch on nerves, and cause other symptoms associated with joint instability, including cervical instability. Prolotherapy to the weakened, injured or lax ligaments involved is offered to stabilize these ligaments and connective tissue.
1. Yacovino DA. Cervical vertigo: myths, facts, and scientific evidence. Neurologia. 2012 Sep 13. pii: S0213-4853(12)00211-3. doi: 10.1016/j.nrl.2012.06.013. [Epub ahead of print]
2. Chau AT, Menant JC, Hübner PP, Lord SR, Migliaccio AA. Prevalence of Vestibular Disorder in Older People Who Experience Dizziness. Front Neurol. 2015 Dec 24;6:268. doi: 10.3389/fneur.2015.00268. eCollection 2015.
3. Kollén L1, Hörder H2, Möller C3, Frändin K4. Physical functioning in older persons with dizziness: a population-based study. Aging Clin Exp Res. 2016 Apr 16. [Epub ahead of print]
4. Ghosh S, Dey S, Guha R. Cervical spondylosis and vertigo: a controversy put to test Indian Journal Of Otology 2009; 15:7-11
5. Machaly SA, Senna MK, Sadek AG. Vertigo is associated with advanced degenerative changes in patients with cervical spondylosis. Clin Rheumatol. 2011 Dec;30(12):1527-34. doi: 10.1007/s10067-011-1770-x. Epub 2011 May 20.
5. Hooper RA, Frizzell JB, Faris P. Case series on chronic whiplash related neck pain treated with intraarticular zygapophysial joint regeneration injection therapy. Pain Physician. 2007 Mar;10(2):313-8.
6. Centeno CJ, Elliott J, Elkins WL, Freeman M. Fluoroscopically guided cervical prolotherapy for instability with blinded pre and post radiographic reading. Pain Physician. 2005 Jan;8(1):67-72.