Excessive Sweating – Hyperhidrosis. Is upper cervical instability the missing treatment?

Ross Hauser, MD

A patient will often contact us that they have a problem with sweating. Their clothes are soaked, they wake up in the middle of the night soaked. They are constantly and continually sweating. They have a diagnosis of hyperhidrosis or simply they sweat a lot and for unknown reasons.

In a search for the unknown reasons the following possible causes were ruled out by various testings.

Sweating problems are a symptom among many.

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.

NOTHING comes back positive, so what can it be? I am sweating all the time. The answer for some is cervical spine instability

Listen to these people’s stories. They have issues with sweating among many different symptoms. Many have a diagnosis of hyperhidrosis – excessive sweating  But their sweating and other symptoms reflect a common origin, a problem in the neck.

I sweat when I need to urinate

Almost 15 years ago I had C4 -C7 laminectomy for spinal cord compression, chronic pain, bladder issues. The surgery did not go so well. I moved onto a C4 -C7 soon after the first surgery. That surgery did not go so well as I continued to have cervical radiculopathy. My current problems include much excessive sweating when I have to urinate. My situation is currently going downhill fast.

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

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.

Ehlers-Danlos syndrome and Hyperhidrosis

For some people with multiple symptoms or concerns, each problem may be treated as its own entity. This may be the case with Hyperhidrosis. Here is another story:

I have been diagnosed with Ehlers-Danlos syndrome, and I have symptoms of blurred vision, eye pain, hyperhidrosis, migraines, neck pain, burning sensation in the face, neck, and upper torso. I am on a lot of medications. For the hyperhidrosis, I have been prescribed oxybutynin. It hasn’t worked.

Symptomatic treatment for Hyperhidrosis

In this section, we are going to take a medical journey that many people take, maybe you did too. It is a list of treatments that you may have tried for your sweating problem. These treatments are considered Symptomatic. They only address the symptoms and not the underlying cause of your sweating. Many of these treatments will be successful, many will not. If you are reading this article and these are treatments you have tried and they have been less than successful, here are the reasons that can be explored. Ultimately, for some people, we will suggest that the problem of sweating and other neurological type symptoms mentioned above, are problems of the cervical spine.

Oral oxybutynin for the treatment of Hyperhidrosis

According to the U.S. National Library of Medicine’s MedLine Plus, Oxybutynin is used to treat overactive bladder, frequent urination, urgent need to urinate, and inability to control urination. In March 2015, a team of researchers published in the journal Skin Appendage Disorders,(1) that Oxybutynin, an anticholinergic drug (a neurotransmitter blocker) was emerging as a treatment of hyperhidrosis. At the time, several studies documented that it is effective in hyperhidrosis treatment. For some people, oxybutynin may be effective. For others not. Let’s look at the research:

In August 2020, researchers published their observations on Oral oxybutynin for the treatment of Hyperhidrosis. The research appears in the journal Dermatologic therapy.(2)

Here are the learning points:

To help understand why the effectiveness of oxybutynin wore off, the researchers looked at the clinical charts of patients who started oxybutynin treatment for their sweating problems and why these people stopped using the medication.

In our opinion, we would suspect that the people who did not respond to oxybutynin in the long-term may have had a cervical spine issue. Oxybutynin does not treat problems of the cervical spine.

Oral glycopyrrolate for hyperhidrosis

The same group of researchers publishing in the August 2020 issue of the journal Dermatologic therapy (3), then explored the use of oral glycopyrrolate for people who did not respond to oxybutynin.

Here are the learning points of that research

So here we have treatments that many people have had. The ones who had success with oxybutynin or glycopyrrolate, are probably not the people we see at our center. We see the people, perhaps like yourself, who continue to have problems of excessive sweating following these medications.

Botox® and the armpits

Here is another case:

I have a physically demanding job, I use my upper body all day long. I worked through a lot of neck and shoulder pain. One day I started noticing that I was having a hard time swallowing. Then I started noticing what I did swallow, I was not digesting. I was sent to a gastroenterologist to treat what was termed “serious acid reflux.” Then I developed a burning sensation in my skin, sensitivity to loud noises, and bright lights. My neck pain continued to get worse and I am constantly cracking my neck. Then I developed this sweating problem. My palms and underarms are always drenched with sweat. I am not wearing cotton gloves to help absorb the sweat, I change my shirt numerous times throughout the day.

I was sent to a dermatologist and he confirmed severe hyperhidrosis. He suggested a prescription-strength antiperspirant, I did not even know such a thing existed. That was not helpful. Then I was told that Botox® injections into my armpits may help. The Botox® would act as a nerve block to block “sweating messages” from going from my brain to my armpits. Then as a last resort, there is surgery to remove the sweat glands.

Botox® injections for axillary hyperhidrosis (excessive armpit sweating) can be very effective for many people. An August 2020 study (4) from Tallaght University Hospital, Dublin, Ireland examined patients who had 5-year follow-ups and treatments of Botox® injections for armpit sweating and found that for many people this would be a successful long-term treatment for their armpit sweating.

Like the people who had successful treatments of glycopyrrolate or oxybutynin, the people who have success with Botox® injections are typically not the people we see in our offices. Where one treatment will work for one condition is usually not in the realm of people we see with cervical spine instability. Let’s look at one more example of treatments.

Ross Syndrome

Ross syndrome is considered a rare clinical disorder of sweating associated with tonic pupil and muscle disorder. Ross Syndrome, like many syndromes related to “mystery ailments,” and “unknown causes,” is a controversial diagnosis. Medical literature only reports 80 cases worldwide. Yet we get many emails and phone calls describing these very symptoms.

An April 2019 paper offers advice to doctors who are looking for diagnostic answers when a person walks into their office with problems of excessive sweating. The paper appears in the Journal of family medicine and primary care.(5)

“Ross syndrome is diagnosed by the presence of the characteristic triad of segmental anhidrosis (the inability to sweat normally), depressed deep tendon reflex (your muscles inability to stretch), and tonic pupils. It is a rare, misdiagnosed autonomic disorder with less than 80 cases reported in the world literature.”

What is interesting in this study, is that as rare a condition is, this medical paper was able to cite two cases. This gives us a clue that this problem is more common than thought. It is not a challenge of understanding the patient’s symptoms, the symptoms are obvious on examination. The supposed rareness of the problem is the inability to accurately diagnose it.

The patients were treated symptomatically with incomplete relief

Here are the two studies:

“Both cases (aged 35 and 58) presented with complaint of decreased sweating over one half of the face and ipsilateral (one-sided) upper limb and trunk and (other-side) contralateral lower limb. There was compensatory increased sweating and hyperpigmentation (changes in skin color) over the remaining parts of the body.

The duration of symptoms was 2 years and 15 days. The patients had variegated skin color as per the above distribution and hyporeflexia (non or less responsive muscles) in lower limbs. One patient also had Holmes-Adie pupil ( larger than normal pupil that responds poorly or slowly to light stimulation). Iodine test showed hypohidrosis in the described areas, which was confirmed by skin biopsy in both cases. The patients were treated symptomatically with incomplete relief.

How were these two patients treated? What made treatment unsuccessful?

“The treatment of this unpredictable disorder is very important though largely unsatisfactory because compensatory hyperhidrosis (sweating disorder) may lead to heat exhaustion and heatstroke. Systemic anticholinergic drugs (parasympathetic nervous system blockers such as propantheline bromide, glycopyrrolate, oxybutynin, and benztropine) and anxiolytics (beta-blockers, amitriptyline, and fluoxetine) are tried though anticholinergic adverse effects may limit their use.

Topical medications (0.5% glycopyrrolate aqueous cream) and local instillation of botulinum toxin may be tried.

Modified iontophoretic devices (electrical stimulation to help administer medication into your body) and thoracic sympathectomy (a surgery where a portion of the sympathetic nerve trunk in the thoracic region is destroyed) for hyperhidrosis have been tried.

Steroids are indicated if autoimmune etiology is evident. However, environmental modification, wearing wet clothes during physical activity, and other coping strategies remain the mainstay.”

This paper made no mention of cervical spine disorders.

In this video, Ross Hauser, MD, and Brian Hutcheson, DC discuss symptoms of abnormal sweating and 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.

But what happens when sweating cannot be controlled? For these people, should we look at their necks?

I have had the tests, no one knows what is causing the sweating. I am extremely sensitive to heat. If I feel the least bit hot, I sweat profusely. Sometimes I get a burning sensation on my toes, hands, chest, and eventually all over my body that last anywhere from 30 seconds to a minute or until the body temperature goes down.

Self-manipulation of the neck was the possible cause of the sweating.

This person became a patient of ours. In a further assessment of his clinical condition, we found that he self-adjusted their neck upwards of  50 times a day. The self-adjustment made his neck pain feel better for a while, then the pain would return and he would self-adjust again. This continued throughout the day and as this person says, upwards of 50 times a day. The tension and pain in his neck not only caused headaches that plagued him, but he also had issues with vision and light sensitivity.

Sweating caused by cervical disc herniation or cervical spine injury or cervical surgery

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.

Compensatory hyperhidrosis and endoscopic thoracic sympathectomy

For some of you reading this article, you may have developed sweating problems because of degenerative disc disease in the cervical spine, syndromes such as Ehlers Danlos Syndrome, thoracic disease – please see our article Neurogenic and Nonspecific-type thoracic outlet syndrome – Diagnosis and treatment, a whiplash injury suffered in a car accident, or a cervical spine surgery.

Compensatory hyperhidrosis is considered a neuropathy problem. It is a side-effect of endoscopic thoracic sympathectomy. Surgery to correct excessive sweating.

Let’s go to the research:

In October 2020, in the journal Medicine (6) surgeons made these observations and explanations as to cause and effect of compensatory hyperhidrosis and studied 44 patients to see what treatments may help them.

Here is the study’s findings:

Suddenly the patient experiences a worsening sweating problem as the excess sweating has now moved into a new area

Let’s review what is happening here:

I sweat on one side, I do not sweat on the other

We are going to look at a case history study. Many of the symptoms reported by these doctors are similar to those we see in our patients. This demonstrates an awareness of doctors to problems we have seen in nearly three decades of helping people with mysterious, rare, or difficult to treat diagnoses.

In these case histories published in the journal Functional neurology (7), doctors helped show many of the challenges we have observed in patients. That is how delicate the cervical spinal nerves and the sweating mechanism is. In 5 case histories, researchers showed that Hyperhidrosis and anhidrosis, the inability to sweat, coexist side by side. In some people they have Hyperhidrosis on one side of the face and anhidrosis on the other side of the face. Hyperhidrosis on one side of the trunk and anhidrosis on the other side of the trunk.

If you are reading this article, it is very likely that you may have one side of your face feel hot, clammy and sweaty, and the other side of your face cool to the touch.

Non-surgical conservative care treatment surrounding the cervical spine

The treatment these patients received was:

Case 1 : A 63-year-old man with a three-month history of excessive right facial sweating.

Case 2: A 44-year-old woman with a three-year history of excessive sweating and warm sensation in her face when playing tennis, regardless of the season.

A brief note on one-side to the other side body temperature dysfunction

In the case above, the woman’s body started to heat up in the area where she had a problem previous of inability to sweat. In the video above at the 1:15 mark, Dr. Hauser and Dr. Hutcheson discuss temperature abnormalities from one side to the other. The learning points are:

Checking the temperature at various points of the body.

Patient demonstration at 1:45 – the clue that temperature dysfunction is being caused by cervical spine instability.

Why just one side? Why is it difficult to understand or diagnose?

Back to the case histories

In these case histories published in the journal Functional neurology. Remember that the patients here were treated at a center specializing in researching physical therapy and physiology.

The treatment these patients received was:

Case 3: A 74-year-old woman with a three-month history of profuse facial sweating, which she experienced on heat exposure and exercise.

Again here, the area that had sweating problems started to heat up when the other areas, where excessive sweating was occurring were being treated.

Case 4:  A 37-year-old woman presented with profuse sweating affecting the left side of her face and extending to the upper half of her body.

Case 5:  A 41-year-old man had suffered from massive sweating since his high school days.

The treatment of cervical spine instability at the Hauser Neck Center – Research on cervical instability and Prolotherapy

In the above article, we suggest that many of the problems related to sweating can be treated by addressing cervical spine instability in the neck. There are many ways to treat this problem. Our preferred choice is regenerative medicine injections that begin with Prolotherapy.

Caring Medical has published dozens of papers on Prolotherapy injections as a treatment in difficult to treat musculoskeletal disorders. Prolotherapy is an injection technique utilizing simple sugar or dextrose. Our research documents our experience with our patients.

In 2014, we published a comprehensive review of the problems related to weakened damaged cervical neck ligaments in The Open Orthopaedics Journal.(8) We are honored that this research has been used in at least 6 other medical research papers by different authors exploring our treatments and findings and cited, according to Google Scholar, in more than 40 articles.

Further reading: Cervical Spine Realignment and restoring loss of cervical lordosis

In our article Cervical Spine Realignment and restoring loss of cervical lordosis, Dr. Hauser presents the case that cervical spine, upper cervical spine, and lower cervical spine instability may be an unexplored cause of your neurologic-like, vascular-like and psychiatric-like conditions and symptoms. It is very likely that you are reading this article as a continuation of your research into your symptoms and conditions and you came here from other pages on this website or that you landed here because a doctor, in many cases a chiropractor, mentioned to you that you have C1-C2 instability or C3-C7 instability. That this cervical instability has caused you to lose the natural curve or LORDOSIS in your neck. Further, that you have started to comes to terms with the understanding that of all the tests that you have had performed by neurologists and cardiologists and the prescriptions offered to you by psychiatrists have never offered a “grand unifying theory” or help in diagnosing what was really wrong with you.

Further reading: Symptoms and conditions of Craniocervical Instability

In this article, Symptoms and conditions of Craniocervical Instability, Dr. Hauser has 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.

For many of these people, symptoms, and conditions extended far beyond the 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.

Treating Cervical Spine Instability is treating the symptoms of sweating and coexisting problems

In this video, DMX imaging displays Prolotherapy results in before and after treatment images. This patient’s treatment had problems of a pinched nerve in the cervical spine resolved.

This video demonstrates the alleviation of cervical disc herniation and the patient’s related symptoms.

Summary and contact us. Can we help you? How do I know if I’m a good candidate?

We hope you found this article informative and it helped answer many of the questions you may have surrounding Excessive Sweating and Hyperhidrosis. Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here.

Please visit the Hauser Neck Center Patient Candidate Form

References for this article:

1 Campanati A, Gregoriou S, Kontochristopoulos G, Offidani A. Oxybutynin for the treatment of primary hyperhidrosis: current state of the art. Skin Appendage Disorders. 2015;1(1):6-13. [Google Scholar]
2 del Boz Gonzalez J, Rodríguez Barón D, Millán‐Cayetano JF, de Troya Martin M. Tolerance of oral oxybutynin in the treatment of hyperhidrosis. Dermatologic therapy. 2020 Aug 14:e14197. [Google Scholar]
3 Del Boz J, García‐Souto F, Rivas‐Ruiz F, Polo‐Padillo J. Survival study of treatment adherence by patients given oral glycopyrrolate for hyperhidrosis following treatment failure with oral oxybutynin. Dermatologic therapy. 2020 Aug 21:e14210. [Google Scholar]
4 Lynch OE, Aherne T, Gibbons J, Boland MR, Ryan ÉJ, Boyle E, Egan B, Tierney S. Five-year follow-up of patients treated with intra-dermal botulinum toxin for axillary hyperhidrosis. Irish Journal of Medical Science (1971-). 2020 Jan 3:1-4. [Google Scholar]
5 Panda S, Verma D, Budania A, Bharti JN, Sharma RK. Clinical and laboratory correlates of selective autonomic dysfunction due to Ross syndrome. Journal of Family Medicine and Primary Care. 2019 Apr;8(4):1500. [Google Scholar]
6 Moon MH, Hyun K, Park JK, Lee J. Surgical treatment of compensatory hyperhidrosis: Retrospective observational study. Medicine. 2020 Oct 16;99(42). [Google Scholar]
7 Iwase S, Inukai Y, Nishimura N, Sato M, Sugenoya J. Hemifacial hyperhidrosis associated with ipsilateral/contralateral cervical disc herniation myelopathy. Functional considerations on how compression pattern determines the laterality. Functional neurology. 2014 Jan;29(1):67. [Google Scholar]
8 Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. The open orthopaedics journal. 2014;8:326.  [Google Scholar]

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