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Ross Hauser, MD.

In this article, I have put together a summary of some of the symptoms and conditions that we have seen in our patients either previously diagnosed or recently diagnosed with Craniocervical Instability, upper cervical spine instability, cervical spine instability, or simply problems related to neck pain.

The condition that is the most perplexing for patients and their doctors to figure out is upper cervical instability. As described throughout the articles on this website, the most important instability in the human body to understand and resolve is upper cervical instability. Why? Because cervical instability can be a  devastating, life altering health consequence. How does a health situation that is so complex and impactful on the entire body go undiagnosed by traditional medical doctors and health care professionals? There are too many symptoms that mimic other conditions.

• Headaches, even suboccipital and occipital ones, are a common complaints. So headache treatments are offered without finding the cause of the headaches.
• Medical doctors are not trained to evaluate the upper cervical spine.
• Static x-ray and MRI analyses often do not show upper cervical pathology.
• Radiologists who read the x-rays and MRIs emphasize the lower cervical vertebrae and discs in their readings, often not even commenting on the upper two cervical vertebrae.
• There are invasive procedures to decrease nerve impulses for the occipital and trigeminal nerve such as radiofrequency ablation and microvascular decompression, so these techniques are emphasized for treatment; however, occipital and trigeminal neuralgia are both typically from upper cervical instability.
• Other common symptoms of upper cervical instability include reduced neck range of motion, neck pain, insomnia, dizziness, lightheadedness, neck pain with movement, preauricular (ear) region pain, ringing in the ear, and vertigo. Again, these are common symptoms for which there are drugs to control the symptoms so upper cervical instability is not in the differential diagnosis. Thus, upper cervical instability is often the missing diagnosis.

Cervical instability affects the functioning of not only the cervical nerves that innervate the muscles and skin of the arms and hands but also the autonomic nerves that control blood pressure, heart rate, digestion, immune system function, breathing, and energy levels. Furthermore, cervical instability affects the neurons involved in the central relay systems in the brain that are involved with vision, proprioception (balance and 3-D perception), hormone levels, and even concentration, memory, emotions and happiness. For many of these people, symptoms, and conditions extended far beyond these problems of neck pain, radiating pain of cervical radiculopathy, headaches, TMJ, and possibly dizziness usually associated with problems in the neck. These people’s symptoms and conditions extend into neurologic-type problems that may include digestion, irregular cardiovascular problems, hallucinogenic sensations, vision problems, hearing problems, swallowing problems, excessive sweating, and a myriad of others.

I want to point out that the symptoms and conditions you will see described below can be caused by many problems. This article demonstrates that craniocervical instability and cervical neck instability can be one of them. Cervical instability is often the missing diagnosis (the cause) for the following neck conditions and symptoms:

Symptoms and conditions of Craniocervical Instability

• Your neck cannot support the weight of your head
• Your head is tilted on top of your neck
• Intracranial hypertension – pressure headaches
• Arterial and Venous Compression related symptoms
• Decreased blood flow in and out of the brain
• Brian fog, concentration difficulties, memory issues
• Dysautonomia: brainstem compression
  • Postural Orthostatic Tachycardia Syndrome (POTS)
• Cardiovascular type disorders
  • Cervical angina
• Digestive problems, gastrointestinal symptoms
  • Swallowing difficulties
  • Hiccups
• TMJ
• Burning mouth and facial pain
• Strange skin sensations
  • Inability to maintain consistent body and skin temperature
  • Excessive sweating, Sweaty hands, and palms
  • Itching skin
  • Red ear syndrome
• Vision problems
  • Transient monocular blindness
  • Oscillopsia
• Ear fullness and hearing problems
• Meniere’s Disease and Chronic cerebrospinal venous insufficiency
• Tinnitus
• Sinus problems
• Empty Nose Syndrome
• Chronic fatigue syndrome
• Dizziness
• Balance problems
• Headaches
• Dissociation, Anxiety and Depression
• Emotional stress

Craniocervical Instability is a structural problem of the craniocervical junction

The caption reads: Anterior view (from behind) of the craniocervical junction (where the cranium and cervical spine connect). Upper cervical ligament instability typically involves the C1 – C2 facet joints which are lateral (side to side) compared to the atlanto-dental (the horizontal distance between the C1 and the Dens protrusion of the C2 vertabrae). Some of the more common measurements taken on lateral view x-rays with the patient in the neutral position include atlanto-dental interval (ADI) and atlantoaxial angulation (AAA), while the lateral mass-dens interval (LDI) and lateral joint space (LJS) are seen on the anteroposterior view. What do these measurements look for? Instability, osteoarthritis and compression. Therefore the relationship of the atlas C1 and axis C2 to the carotid sheath contents of the internal carotid artery, internal jugular vein, and vagus nerve is easily appreciated.

Many people have mechanical cervical instability.

Many people now have mechanical cervical instability. Most have symptoms but they do not realize it is coming from neck instability.  As we all spend more time bent over texting on smartphones, hunched over a computer or reading, we are slowly stretching the ligaments in our necks. We may not yet have symptoms, but note our spinal curves are changing. It is almost unheard of today to see a normal cervical lordotic curve; even pre-adolescent children have straight curves because of all the looking down they do while playing games on their smartphones or tablets. The chronic loss of the lordotic curve occurs because the ligaments in the neck are stretched out. The long-term danger of this is that the forces on the facet joints and discs in the neck to hold the head up are substantially increased I and thus make these areas more vulnerable to injury during whiplash or other neck forces. The loss of the cervical curve can occur acutely after a whiplash, but when the curve is lost long-term, its primary cause is ligament injury. When the lordotic curve is lost, treatment is needed for cervical stability along with certain unique curve correction techniques with chest and head weights.

If you have been diagnosed with  Craniocervical Instability

Craniocervical Instability is a structural problem of the craniocervical junction.  If you have been diagnosed with  Craniocervical Instability, your doctors have concluded that you have a structural disorder at the back of your head where the base of your skull (the occipital bone) and C0 (the atlas) – C1 vertebrae (the axis) function together. You may have been relieved to get this diagnosis as your medical journey took you on a long meandering course from specialist to specialist with no answers. Let’s start exploring the symptoms and conditions. In many people this instability is not limited to only this region of the cervical spine, it extends through the neck from C0 – C7 and leads to issues of atlantoaxial instability (c1-c2), Upper cervical instability, and compression of the brainstem and cervical neck instability.

When your neck feels like it cannot keep your head up – “I can’t keep my head up”

There are obvious signs that a patient suffers from craniocervical instability or upper cervical instability. One sign is their inability to keep their head upright. As some of you reading this article are probably aware through your own first-hand experience, and through an eventual diagnosis of Dropped Head Syndrome or Isolated neck extensor myopathy, there are many things that can cause this problem. In your own experience, you may have already been through a barrage of tests to rule out Lou Gehrig’s disease, Parkinson’s disease, head and neck cancer, myasthenia gravis among other neurological or hereditary disorders. Once all these things are ruled out, your Dropped Head Syndrome may become a diagnosis of isolated neck extensor myopathy. Sometimes you will carry both diagnoses. But simply stated, you cannot keep your head upright.

Your treatment history may have included medications, physical therapy, chiropractic adjustments, and cervical collars.  You may be wearing a cervical collar right now as you are reading. You may have a strong recommendation from a neurosurgeon to consider cervical spine fusion surgery.

What are we seeing in this image?

Craniocervical instability or upper cervical instability can be caused by the stretched rear or posterior neck ligaments. Stretched ligaments can occur over time in the CREEP phenomena which is a degenerative condition brought on by wear and tear from the head down work (computer) or chronic cell phone use. Stretched ligaments can also occur as a result of whiplash or other injury and a diagnosis of hEDS or Ehlers-Danlos Syndrome.

Ligament Creep can cause a chronic cycle of neck pain, headaches, and the many symptoms and conditions that I will outline below. As the cervical spine ligaments become weaker, the head-forward position increases. The weakened ligaments can no longer keep the cervical vertebrae in proper alignment.

This can cause the neck muscles to start to tighten and chronically spasm. This will limit the range of head motion and decrease the load on the ligaments. The muscles are trying to prevent you from turning your head so you do not damage yourself further. Muscle spasms are a defense mechanism.

However, the muscles were not intended to be a defense mechanism. This extra demand cervical spine instability is putting on them can quickly cause the cervical spine muscles to atrophy. Injured ligaments, unfortunately, heal very slowly, this has to do with the poor blood circulation they get (this is why ligaments are white and muscles are red – muscles get blood, ligaments don’t.)

Damaged ligaments and atrophied muscles cause hypermobility of the cervical spine vertebrae. Floating vertebrae leads to pinched nerves, pinched arteries, pinched veins. All leading to possible situations of pain, blood flow problems to the brain, and the neurologic-type symptoms and conditions I will describe throughout this article.

Dropped Head Syndrome – Isolated neck extensor myopathy, research on treatments

You have probably tried all these treatments mentioned above. You may have a strong recommendation from a neurosurgeon to consider cervical spine fusion surgery. In my article on Dropped Head Syndrome, I outline our non-surgical treatment methods for restoring cervical ligament strength with Prolotherapy injections (explained below) and correction of the natural cervical spine curve that is lost in the forward head – Dropped head syndrome phenomena.

What are we seeing in this image? Craniocervical instability – upper cervical instability

The first of the four images is the Lordotic curve, the natural curve. Over the course of your medical history, this natural neck curve has deteriorated into a condition and symptom causing structural problems. The progression demonstrated in this image passes through the phases of the Lordotic (normal) to the straight spine (Military curve) to the Kyphotic curve where the cervical spine is now curved in the wrong direction. Finally, the degenerative condition continues to the “S” curve configuration. The cervical spine is twisted out of shape. With this twisting comes the stretching and tearing of the cervical spine support ligaments.

What are we seeing in this image?

In this image from a digital motion x-ray, we can see how a reverse curve or “S” curve can lead to problems of the vertebrae banging against the back of the head (the occiput), nerve impingement, or pinching, and reducing blood flow into the brain. With these problems comes the long list of “unexplained” neurological symptoms the patient may suffer from.

A Digital Motion X-Ray or DMX is a tool we use to help understand a patient’s neck instability and how we may be able to help the patients with our treatments. In the illustration below a patient who suffered from upper cervical instability demonstrated hypermobility of the C1-C2. This hypermobility can result in common symptoms of neck pain, headaches, dizziness, vertigo, tinnitus, concentration difficulties, anxiety, and other symptoms common in TMJ/TMD patients.

My head is tilted, I have terrible spasms, I was diagnosed with Cervical dystonia – spasmodic torticollis

Among your symptoms, one day you started having painful, involuntary muscle spasms in the neck. These were much worse than the muscle spasms you were use to. Coinciding with this was your head started rotating and tilting to one side as these spasms got worse and it became difficult to get your head back in line. Some describe this as a feeling of a clenched fist in their neck.

Your pain sometimes starts suddenly, sometimes it goes away, sometimes the pain stays for a while and becomes continuous. When the pain spasms become more frequent you notice that is when your head tilts the most, you get a feeling of near incapacitating tightness in your head, neck, shoulder, and upper back.

At this point, your medical journey began to accelerate. Your doctor may have made a recommendation that your issue is best served by a physical and occupational therapist who specializes in neurological disorders. Possibly this is the first time you heard you had a neurological disorder and this may have frightened you very much.

Your doctor tells you that he/she suspects Cervical dystonia also called Spastic Torticollis or Cervical Torticollis. It is not curable, but it is treatable. Your doctor may suggest a specialist who can prescribe and recommend various muscle relaxants. You probably received the first of your muscle relaxant prescriptions at this consultation.

Then your story may have taken a turn like this:

After I starting receiving treatments, specifically botox injections, I started to feel better. I was advised that if my condition worsened, we could continue on with the botox. My condition worsened. At this point, I was being tested for everything including looking for a brain tumor. When nothing came back, my doctors began to explore that my problems were phycological. I hear them talking that they think this is “all in my head.” All the treatment I am getting at this point is Klonopin for panic disorders and anxiety.

Let me point out that some people do very well with Botox injections. The above represents one story.

In my article Cervical dystonia and spasmodic torticollis treatment I describe that when a patient who is suffering from dystonia comes into our clinics looking for help and some answers it is because their condition has worsened and they have become “difficult to treat.” The reason that some suffer from worsening and developing symptoms is from craniocervical instability – cervical spine instability.

In this article, I also discuss the problems of a diagnosis, symptoms of cervical disc disease, essential tremor, anxiety, and depression. I also discuss why prescription medications may have not helped you, Why relaxation techniques did not help and why doctors often turn to psychotherapy. I also look at C1-C2 Surgery.

Finally, I outline treatments as demonstrated through the story of a patient. The patient struggled with spastic torticollis for several years prior to coming to our office. Because spastic torticollis is a condition in which the head will twitch or turn uncontrollably and tilt to one side, our patient needed to turn her body to the side in order to see straight ahead.

What are we seeing in this image?

In this image, we see a depiction of a muscle spasm in the back of the neck. Why the muscle spasms, or why it gets thicker is a response to cervical spine ligament injury. The muscle is trying to hold things together to prevent the nerve or cervical arteries from being impinged.

In this video, Ross Hauser, MD gives a brief outline of  Cervical dystonia – spasmodic torticollis treatment

Intracranial hypertension – pressure headaches and other conditions

One of the clues that the head has increased having intracranial hypertension is a morning headache which may awaken one from sleep. This is believed to occur because cerebral edema is worse during the night due to the laying down position. Other clues are that the headache is worse with coughing, sneezing and bending, all of which increase having intracranial hypertension. Sometimes there are also personality changes. Typically, conditions which involve increased having intracranial hypertension worsen over time, so the symptoms get worse.

We see many patients who have a serious health challenge in having intracranial hypertension. In many of these people, intracranial hypertension was not initially thought of as a problem, the symptoms manifest from this problem were. So their doctors instead tackled the symptoms that these people were facing not the cause.

Symptoms that included dizziness, headache, vision problems such as sensitivity to light were exaggerated. Pupillary hippus dilating is a common condition we see in patients. This is where constricting of arteries and veins in the cervical spine can cause problems with light sensitivity and the pupil’s failure to respond correctly to light sources. These people also faced symptoms and diagnosis of Tinnitus or ringing in the ears, neck pain, and tremors.

Once a problem of intracranial hypertension or a  build-up of pressure around the brain was discovered, a myriad of tests and treatments were tried. Once obvious causes such as head injury or stroke were ruled out, initial testing may have looked for causes in blood clots, infection, and tumors. Once tests ruled those out as causes your diagnosis of intracranial hypertension, you then got an updated diagnosis of idiopathic intracranial hypertension, which means no one knows why you have intracranial hypertension.

Once these tests are performed you may be given a treatment plan that includes weight loss, a review or reduction or repurposing of the medications you are on, you may be given medications to reduce the production of cerebrospinal fluid, steroids, routine spinal taps to remove excess fluid buildup.

For many people, these treatments may have worked wonderfully. These are not the people that are contacting our office. We see the people that continue to have these symptoms and challenges despite years of treatment. So what is it that we can offer them? The possibility of a missing diagnosis. For some of these patients, not all, there is a problem of cervical spine instability causing a problem of cerebral spinal fluid drainage and buildup.

Blurry vision, eye pain, eye pressure, light sensitivity and other vision problems, along with symptoms above among the more troubling and disabling symptoms that are often due to cervical spine instability. An summary and explanatory notes of this video can be found here at: Blurry vision, light sensitivity, brain fog, increased ocular pressure and cervical Instability.

What are we seeing in this image?

A cause of the problems of intracranial pressure and blood flow into the brain may be found in the relationship of the internal carotid artery to the upper cervical vertebrae. The internal carotid artery sits just in front of the transverse process of the atlas (C1) and the axis (C2). Even its blood flow can be constricted or blocked by atlantoaxial (upper) cervical instability.

In my article Cervical Spine Instability, Vein blockage, fluid build up and intracranial hypertension, I discuss problems of venous obstruction in the cervical spine, “sludge” buildup in the brain caused by malrotation at the C1, loss of blood flow to the brain, Vertebrobasilar insufficiency – Drop Attacks, Bow Hunter Syndrome, and vision problems and we develop non-surgical treatment programs surrounding Prolotherapy injections into the neck along with a program to correct the natural curve of the neck.

Cardiovascular type disorders

What are we seeing in this image?

This image describes the impact of compression of the vagus nerve and the glossopharyngeal nerve on heart rate and blood pressure

• Many of the vagus nerve sensory fibers that regulate blood pressure are in the carotid artery and the glossopharyngeal nerve fibers. The nerves are part of a network that carries impulses to the brain that tells the brain what is going on with heart rate and blood pressure moment to moment.
  • For example, if your blood pressure is going low you need this network to alert the adrenaline system or the sympathetic nervous system to regulate your blood pressure.

 

Dysautonomia: brainstem compression

We get a lot of emails from people suffering from symptoms of tachycardia (rapid heartbeat), dizziness, fainting, headaches, vertigo, excessive fatigue, digestive problems including nausea, weight loss. Because of the fainting symptoms, especially the “blackouts,” people would find themselves in the emergency room because of injuries they sustained in the fall to the ground. They would also tell us of their need for a companion to accompany them when they ventured out.

Some people reported that every time they got to their feet or stood up, their heart would race. Their heart may race wildly after eating. Eventually, some would be diagnosed with panic disorders and be sent on a different path of treatment, one towards physiatrists and mental health professionals and months, possibly years of testing various anxiety and panic disorder medications that seemingly did not help, and worse accelerated “bad thoughts.”

The autonomic nervous system (ANS) is made up of nerves that control the automatic functions throughout the body. It is the master regulator, controlling heart rate, blood pressure, temperature, respiration, sweating, digestion, and other vital functions. These systems operate without consciously thinking about them because the ANS provides the connection between them and the brain.

The ANS is made up of two subsystems: the sympathetic autonomic nervous system (SANS) and the parasympathetic autonomic nervous system (PANS). Most organs are directed by both the sympathetic and parasympathetic systems. The SANS is usually more of a stimulatory system, increasing heart rate and blood pressure when necessary.

Dysautonomia refers to problems of or dysfunction of the autonomic nervous system. Since the ANS regulates automatic or involuntary bodily functions, such as controlling the activities of organs, glands, smooth muscles, and cardiac muscles, when the ANS malfunctions, the organs it regulates malfunction. For this reason, when individuals suffer from dysautonomia, they often exhibit numerous maladies and symptoms.

For a further discussion on Dysautonomia and POTS (Postural Orthostatic Tachycardia Syndrome) and the Ehlers-Danlos patient please see my article: Dysautonomia and POTS.

Postural Orthostatic Tachycardia Syndrome

In my article Postural Orthostatic Tachycardia Syndrome (POTS), the Vagus Nerve and Cervical Spine instability I discuss  how cervical instability affects the function of the heart including blood pressure variations and rapid heartbeat. POTS is the most common diagnosis or form of dysautonomia. The symptoms such as lightheadedness, palpitations, and tremulousness and are characterized by orthostatic intolerance (this is the development of many of the symptoms just described when a person stands up. These same symptoms are also relieved when a person lays down.) These symptoms can be present without with or without associated orthostatic hypotension (your blood pressure drops drastically when you stand up), and excessive autonomic system stress. One observation can be typically given in these people with these symptoms, their body is not correctly responding to a change from laying down to standing up straight. This incorrect response may be seen as

• Excessive heart rate upon standing  characterized by ai increase of 30 beats per minute or greater within 10 minutes of standing from supine, or greater than 120 bpm while upright.
• Tachycardia (a heart rate over 100 beats per minute) is often accompanied by a mild decrease in blood pressure. Sympathetic overactivity causes tachycardia, mild hypotension, with brain and other organ hypoperfusion (a reduction of blood flow) causing a host of other symptoms.

Arterial and Venous Compression related symptoms

What are we seeing in this image?

The brain needs to drain out or flush out toxins and refill itself with fresh fluids. In the image to the left, I point out that obstruction of the veins and arteries will cause a “clogged toilet.” What happens when the toilet clogs?

• The arteries that bring fresh oxygen, nutrients, and clean fluids to the brain will be impeded.
• The veins that help flush out toxic buildup will clog.

Ultimately this will result in an accumulation of cerebrospinal fluid in various parts of the brain including the frontal lobe. This will destroy neurons and brain tissue. This can be one explanation for the problems of memory, cognitive function, and brain fog described by some patients with cervical spine instability.

To the right we see a brain without obstruction and the flow of blood in and blood out is not impeded.

While most people understand vertebral and carotid arteries supply the brain with blood, oxygen, and nutrients, few are aware that an intricate network of lymphatic cells and veins drain the brain. Obstruction of venous brain output is called Chronic Cerebrospinal Venous Insufficiency (CCSVI).

For good brain health, the blood supply and drainage must meet the demand of its metabolic activity. Brain intelligence and problem-solving areas, such as the anterior cingulate cortex and front lobe cortex, experience the highest metabolic demands and are very susceptible to injury from Chronic Cerebrospinal Venous Insufficiency. When these vital areas of the brain become injured, the first noticeable symptom will often be brain fatigue or brain fog, and if the brain toilet is not unclogged, will progress to extreme lethargy, emotional numbing, dissociation, severe depression, and hopelessness. Even if the brain toilet obstruction is low-level, if it continues, the slow but progressive destruction of brain tissue and brain neurons will result.

As more brain tissue is lost (front lobe atrophy, for example) mental capacity and emotional well-being continue to decline. We have personally seen many young people in their 20s who appear to have Alzheimer’s dementia. With the resolution of their neck instability and injury, which caused their clogged brain toilet, their intellect, emotional stability, and mental capacities return.

Digestive problems 

Perhaps somewhere on your journey a chiropractor, acupuncturist, or neck specialist connected your nausea to dizziness caused by neck instability. You knew there was a connection but you also knew there was much more to this than dizziness-induced nausea.

We see many people who in their own research started putting together the pieces as to why they had the many symptoms and conditions they do. They may have discovered that their digestive problems may be linked to their neck problems. This was something they had not thought of initially as is attested to by the tone of some of the emails we get from them. It is a tone of discovery. Their emails go something like this:

• I had a whiplash injury that was not properly treated. I developed upper cervical arthritis. I have been getting regular colonics, I have malabsorption of food, bloating, and food sensitivities. After reading about the vagus nerve, I started to think my neck was the cause of my stomach problems. 
• I have headaches, occipital neuralgia, and suboccipital headache, I also have TMJ and teeth grinding. I also have a lot of digestive issues including gas, bloating, foul taste in my mouth. My doctors have been open to exploring vagus nerve compression with me. 
• I have been going to doctors for years, they tell me I am fine but I am not. I have persistent tinnitus which gets worse when turning my head to either side, digestive issues, pain in the back of the head, and more. 

People like this, people perhaps like you, have been sent to the Gastroenterologist, and then sent on to a more specialized Gastroenterologist. Over the course of their visits, they were given new diet rules, new medications, new eating suggestions. From many, there was little symptom relief, seemingly no answers for their digestive problems such as bloating, sensitive stomach, constipation, diarrhea, and a sense that their stomach was not emptying. This led to recommendations for surgeries.

Digestive problems are conditions and symptoms we see regularly in our patients with neck pain and instability. Our treatment programs for addressing the possible craniocervical instability and cervical neck instability are described in these articles: Neck instability and digestive disorders, Neck instability nausea, gastroparesis, and other digestive problems, Pyloric stenosis, and SIBO: Small intestinal bacterial overgrowth.

What are we seeing in this image?

In our example stories we hear from patients, they talk about making a connection of some type of disruption to their vagus nerve function and their digestive problems. Here we show that:

In the illustration below, the many things the vagus nerve is responsible for are outlined. Highlighting digestive disorders, we see that the vagus nerve:

• Controls throat muscles to assist in swallowing
• Regulates insulin secretion and glucose balance (homeostasis) in the liver
• Regulates and controls digestion. Provides your brain with the feeling of satiation or “I’m full.” Helps regulate gastric juices, gut motility (the ability to move food through the digestive tract), and the production and regulation of stomach acids.

Gastrointestinal symptoms and vagus nerve compression

In this video Ross Hauser, MD. discusses a myriad of gastrointestinal symptoms that may be caused by vagus nerve compression typically found in cervical spine instability.

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Swallowing difficulties

Nor could you make sense of the fact that you may have had swallowing difficulties, a choking sensation, and a disrupting gag reflex. You may have had chronic hiccups and coughing when you tried to swallow,  These were symptoms that you could not attribute to dizziness insured nausea nor could specialists pinpoint some type of hernia.

Some patients experience a weird clicking sensation in the neck and/or tongue. Others feel like they cannot push the food back for a complete swallow because they sense their tongues are not working.

I have a very extensive article: Cervical disc disease and difficulty swallowing – cervicogenic dysphagia that I invite you to refer to: Below is a summary.

Treating Cervical Spine Instability is treating swallowing difficulties

• Cervical instability in the neck has been linked to swallowing difficulties, diagnosed as cervicogenic dysphagia.
• Cervical instability has been linked to cervical spine nerve compression which can be an “unseen” cause of swallowing difficulties.
• Cervicogenic dysphagia is not a problem that can be treated in isolation, it is likely one of a myriad of symptoms related to neck pain and neck hypermobility.

I also discuss:

• Treating Cervical Spine Instability is treating swallowing difficulties.
• A link between cervical spine instability to swallowing difficulties used to be rarely acknowledged and for the most part ignored.
• C2 malrotation can cause swallowing difficulties.
• A story: “If she held her head still, she was able to swallow.”
• Swallowing difficulties and Diffuse idiopathic skeletal hyperostosis – “an underappreciated phenomenon.”
• Swallowing difficulties: A problem of autonomic nervous system dysfunction?
• Swallowing difficulties: A problem of posture?

C2 malrotation can cause swallowing difficulties

In this x-ray from one of our patients, we can display C2 malrotation. The dotted center line represents where the center of the C2 should be. We see that the C2 is shifter far over. Restoring the C2 to its natural position can alleviate swallowing difficulties as well as many symptoms attributed to cervical spine instability.

In this video Ross Hauser, MD explains the functional dynamics and possible solutions to swallowing difficulties.

Hiccups

It may have been when these added symptoms came into play with your digestive problems, or that they came on separately, that a specialist may have suspected some type of neurological disorders. For more on these symptoms as they may be connected to Craniocervical Instability see my article:  Hiccups and neck instability, difficulty swallowing – cervicogenic dysphagia.

Chewing and TMJ

Some people will come in with a history of a TMJ diagnosis and neck pain as part of their list of conditions and symptoms. In other of our articles, we discuss symptoms of unresolved TMJ, face, ear, and throat pain as well as problems of TMJ and tinnitus as problems that may be caused by Craniocervical Instability and cervical spine and neck instability.

In these articles we discuss treatment options for people who tell us a medical history that sounds like this:

• I have TMJ only on my right side, and that is the side I have tinnitus. I wear a neuromuscular orthotic at night. My surgeon told me that we have to wait a few months to see if this helps before we can move onto surgery. I have been wearing it, it is not helping, but I have to wait some more. I need help today.
• I have TMJ, tinnitus, digestive problems, and a list of other symptoms. I was one of the people who got SSRIs for anxiety and later it was found out they were making my tinnitus worse. Now my doctors are looking at the low vagal tone. I have a heart rate variable monitor to check my vagus nerve function.

Burning Mouth Syndrome

If we took the combined emails we received about problems of Burning Mouth Syndrome, a common thread would create a cumulative person’s that would go something like this:

My mouth and tongue feel like they have been burnt, like from a hot spoon or scolding coffee. I went to the dentist to see if this was a problem with my gums or an infection in my teeth. None of the x-rays showed anything. He told me that he thought it was burning mouth syndrome. Nothing could be done for it except anti-depressants. When I went to my doctor, I was referred to a specialist, a Psychiatrist.

Many people with face and/or mouth pain have been chasing the cause of their symptoms for years. The upper cervical area of C1, C2, C3 is where the important nerves that control the motion of the tongue, as well as sensations of the mouth, are located. When the movement of the upper spine becomes unstable, the bones can pinch on nerves, veins, and other vital structures that run through the neck.

A Patient’s Case History – Burning Mouth Syndrome

• The patient is a young mother with horrible symptoms of burning mouth, the top of the roof of her mouth is burning, the tongue is burning, the back of the throat is burning,
• She has had these symptoms for two years.
• The patient has seen many physicians,  dentists, ENT specialists, and no one has had any success at relieving the terrible burning sensation.

Dr. Hauser at 1:00 of the video:

Why I believe burning mouth syndrome is from cervical instability, specifically upper cervical instability

• Please refer to my article on Burning Mouth Syndrome for more information on this condition.

Neck-Tongue Syndrome is considered a rare disorder. It is considered so rare that when learning institutes or universities get a patient that is confirmed with Neck-Tongue Syndrome they write up a case history to share with their colleagues because of the rareness of the diagnosis. But how rare is this problem or is it simply misdiagnosed or misunderstood and more apparent than initially thought.

In our office, we see many patients with numbness or other unusual sensations in the tongue. While this may be their most troubling symptoms it is rarely a symptom that the patients have by themselves. Accompanying this tongue numbness can problems of neck pain. This has been described by other doctors as well. For the research please see my article: Neck-Tongue Syndrome treatments

Strange sensations in the skin

What are we seeing in this image?

In other articles on this website, I explore problems that many of the people we see have. Symptoms including tactile allodynia or painful to the touch skin, skin sensations where one-half of their body will feel hot and one-half of their body will feel cold, rashes, and problems of sweating. The sensation is felt as the nerve impulses go up the posterior columns of the spinal cord to the parts of the brain that sense stuff that is the somatosensory centers of the brain. But what happens if this messenger – information highway has a roadblock or traffic is being diverted from and many of the highway lanes are closed? The messages move more slowly, priority messages may be delayed.

In this image, we see that this patient has cervical spine instability. This is allowing the rear or posterior spinal canal to hit against the walls of the spinal canal. The pressure being created by hypermobile, unstable cervical vertebrae was causing this patient’s whole body to be in a state of distress. They had the sensation that their body was buzzing or vibrating, their skin had different temperatures from one side to the other, and itching sensations consistent with the sensation that something was crawling on them. Our treatments to alleviate this patient’s problems focused on removing the pressure on the spinal cord by stabilizing the cervical vertebrae and restoring the natural curve of the cervical and thoracic spine with Prolotherapy injections. This is explained below.

 

You are hot on one side of your body, cold on the other, you sweat all the time, but only in patches

Patients who suffer from craniocervical instability and cervical spine degenerative disease and instability may have a condition where they have an inability to regulate their body temperature. For some, this may have occurred after a cervical spine fusion. In our world of cervical spine instability, we have been helping patients for decades who may have been dealing with chronic and years ongoing neurologic-type symptoms that may reveal themselves as temperature instability. In these patients we may explore a chronic hypothalamic mis-messaging (compressed nerves sending confusing messages to the hypothalamus, the gland that regulates body temperature), and, a neurogenic inflammatory response (nerve inflammation – something, like a disc or vertebrae is pinching the nerve). We look for pathologic changes in cerebral blood flow (the patient does not get enough blood to the brain). There are science and research behind these observations and treatment guidelines, please see our article on Thermoregulatory instability and a patient’s inability to temperature regulate.

Hot and cold, sweaty hands

A patient will tell us on their first visit:

The symptoms that confuse my doctors the most is my ability, depending on how I stand, is to make my hands feel hot or cold, sweaty or dry, pale or red in color. They tell me that this is a neurology problem. I do not like having sweaty palms.

In the video below with Ross Hauser, MD, and Brian Hutcheson DC, a discussion of chronic skin sensations that can be common symptoms and findings in cases of cervical instability. These include symptoms like abnormal temperature regulation over half of their body or certain areas that are hot or cold compared to the rest of the body as well as specific areas that are hypersensitive or numb compared to the rest of the body, and other odd skin sensations, including localized swelling, vibration, and severe itching that have not been resolved by other traditional treatments by a dermatologist, rheumatologist, neurologist, etc.

Itching skin

When people have itching of unknown origins they will be recommended over to dermatologist care. If you suffer from itching skin and rashes, this probably happened to you. The initial treatments offered were probably more potent or heavy-duty prescription ointments and creams to those you had already bought over the counter or on the internet. When these treatments are not working or have been eliminated from being useful for you, the next step is of course to dig deeper and look for other things.

Patients who suffer from craniocervical instability and cervical spine degenerative disease and instability may have problems of skin rashes and itching. The problems of itching can in itself be challenging. Is it a problem of the skin and skin rashes or is it a problem of neurology and a symptom more on its own? We have seen patients with uncontrolled itching from an unknown source. In some of these people, it was coming from the patient’s neck and cervical spine instability.

We have a detailed article on this one condition on our website that features research, clinical observations, and patients describing treatments and challenges of Brachioradial Pruritis and Neuropathic itch.

Bugs crawling on my skin

People will contact us with a diagnosis of difficult-to-treat formication, that is the sensation of creepy crawlies or bugs crawling on your skin. The medical term formication comes from the Latin for ants and can be translated as a condition of “ants crawling on the skin.” These people may have a diagnosis of tactile hallucinations, a strange sensation where the skin feels things that are not there, such as a touch, or heat, or any sensation that one would “feel.”

As these people got deeper and deeper into their testing and diagnosis because a cause of these symptoms could not be found, some of their doctors believed these people to be delusional and psychiatric examinations were recommended.

We have a detailed article on Tactile hallucinations and Formication where we explain that while formication and tactile hallucinations can be seen as symptoms of dementia or advancing mental illness, vitamin deficiency, or a hormonal problem in post-menopausal women, we present the case that in some people, these symptoms are part of a myriad of “neurological-type” disorders caused by Craniocervical Instability and cervical spine and neck instability.

That is, in some people, these conditions can be caused by pressure or compression of the posterior spinal cord caused by increasing spinal tension created by a poor cervical curve or neck instability.

Red Ear Syndrome

We often see patients with a problems that cannot be diagnosed or explained. In this case they have many symptoms and conditions but one is more peculiar than others, it is a red painful ear and accompanying neck and jaw pain. Now there is an actual condition called red ear syndrome where a person gets unilateral or bilateral attacks of paroxysmal burning sensations and reddening of the external ear.

The attacks can last a few seconds to hours. Interestingly, the episodes can be brought on by rubbing or touching the ear, heat or cold, chewing, brushing of the hair, neck movements or exertion. When motion of the temporomandibular joint or neck can exacerbate the symptoms or bring them on, one has to think of a cervical-autonomic or trigeminal nerve cause. This is exactly what others believe as well.

The problems of Excessive Sweating

If you have a problem with sweating, it can be caused by many factors including those mentioned above. But if you suffer from excessive sweating as one of many other symptoms, the causes have to be looked at in neurology. For many people we see, especially those with moderate to severe neck problems, we start looking for clues that the sweating is coming from cervical spine instability.

We do realize for some of these people, sweating becomes a primary concern and they become very self-conscious of people looking at their excessively wet clothes. Of the many of their symptoms that the people want to be treated, is the problem of excess sweating.

The extreme sweating is very difficult to manage, I have to change my clothes many times a day.

This is an example of what we hear from people at our center:

I have a diagnosis of Occipital neuralgia. My doctors tell me I have compression at C2. I have headaches, syncope (fainting), nausea and vomiting, blurred and double vision, swallowing difficulties, migraines, heat intolerance, and extreme sweating. The extreme sweating is very difficult to manage, I have to change my clothes many times a day.

Sweating caused by cervical disc herniation is something we see in patients. Yet for many, this is a controversial issue. Controversial means that there is not enough published research to make an opinion one way or the other. For people who have Hyperhidrosis, there is no real controversy. They have it, and if you are like many, are reading this article because you suffer from many symptoms that your doctors cannot help, the controversy rests in the inability to be treated. Please see my article The problems of Excessive Sweating – Hyperhidrosis. Is upper cervical instability the missing treatment?

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