Neck-Tongue Syndrome treatments

Ross Hauser, MD

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 itself. Accompanying this tongue numbness can problems of neck pain. This has been described by other doctors as well.

A paper published in the journal BMJ case reports (1) offers this description of the problem.

“Neck-tongue syndrome is a rarely reported disorder characterized by paroxysmal (sudden or acute attacks or) episodes of intense pain in the upper cervical or occipital areas associated with ipsilateral (one-side of the neck and/or head) hemiglossal (one half of the tongue) dysaesthesia (a sensation that is not right or normal) brought about by sudden neck movement. The most likely cause of this clinical entity is a temporary subluxation of the lateral atlantoaxial joint with impaction of the C2 ventral ramus (nerve) against the articular processes (the back of the cervical vertebrae) on head rotation. Neck-tongue syndrome is an under-recognized condition that can be debilitating for patients and challenging for the treating physicians.”

But as mentioned, this problem of one-half sided tongue numbness is usually one of many problems that a person will suffer from. We often see and hear from people who describe the following challenges they face:

My tongue is always numb and that is just the start of it.

I have problems with my tongue, it is always numb and sometimes it will not even move. It is causing problems with my speech and I have swallowing difficulties. I also have jaw pain, neck pain, and random headaches. I have been going to doctors for years and I have not been getting any help. They think it has to do with the nerves in my neck and if I rest it it will go away by itself. This is not happening, it is not going away with rest and in fact my problem is getting worse. My new set of doctors want to give me a lot of medications. Some are the same ones that I have had before. Now they want to increase my doses so these medications can “do some good.” I am not convinced of that.

My tongue feels numb all the time but there is “nothing wrong with me.”

My tongue feels numb all the time. I also have neck pain and headaches. I have seen regular doctors, ENT doctors, neurologists , chiropractors, herbalists, and others. I have a lot of MRIs and CT scans that say nothing is wrong with me.

An excess of saliva and tongue numbness

I have a problems with excess saliva and a numb tongue. I have been to one specialist after another and and they tell me my saliva glands are fine it must be something else. No one has been able to tell me what “something else is.”

I have neck pain, so my doctors think some of my symptoms have something to do with my neck

I have so many problems, but I feel that everything going on with me has something to do with my neck. I have neck pain that is chronic and severe at times. When it is more severe I get worsening symptoms of my other problems. I have difficulty swallowing, my vision is blurryear fullness and a sensation that it is field with liquid, I have blood pressure spikes, digestive problems, and more. I have seen a cardiologist, an ophthalmologist, and a gastroenterologist, all on the recommendations of my doctor and a neurologist that I must have some time of nerve damage or dysfunction or a pinched nerve in my neck. I have an MRI that show slight to moderate disc disease in C1-C2.

Neck-Tongue syndrome has been classified into two categories:

“. . . why patients with neck problems walk around for years without hope or optimism that their problems can be solved”

Other papers besides the research listed above isolated problems of Neck-Tongue Syndrome to problems of cervical neck instability caused by loose and weak cervical ligaments and loose, hypermobile, cervical vertebrae. In my article on cervical neck instability I write:

“The concept of ligament laxity or cervical neck instability being caused by ligament damage is not so simple for doctors to understand. This may be why patients with neck problems walk around for years without hope or optimism that their problems can be solved.” 

Early in 2018, doctors at the University of California, San Francisco (UCSF) Pediatric Headache division and Child Neurology division, teamed with doctors at Boston Children’s Hospital, the University of California, Davis, Department of Neurology and Pain Management Department, researchers from the University of Newcastle, Australia and researchers at  King’s College London, London. What they were looking for were answers to Neck-Tongue Syndrome. What they found was something we have long written about. The problem these patients are challenged with may be treated by addressing supportive structure ligament weakness in the neck and jaw.

In a paper published in Cephalalgia: An International Journal of Headache, (2) these researchers made these observations:

The researchers note 39 case histories

Lastly, these researchers suggested that Neck-Tongue syndrome should be re-instated in the International Classification of Headache Disorders. A guide for treatments for various disorders causing headaches. Neck-Tongue syndrome has been removed from this index for doctors.

Discovering treatment options

The seeming rarity of this disorder as lead to numerous studies published in the medical literature describing the patient’s condition and symptom management

In April 2018 doctors in Ireland reported in the Journal of Child Neurology (3) three cases:

In the Journal of Chiropractic Medicine, (4) a case of a 34-year-old female patient who sought treatment at a chiropractic clinic for symptoms involving neck pain associated with left-sided paresthesia of the tongue that had persisted for more than two 2 years.

A case in The Journal of Orthopaedic and Sports Physical Therapy: (5)


NOTE: some of the key points to look at in this research. The main treatment was physical therapy to strengthen the muscular in the cervical spine. This had some positive effect. The physical therapy was given in a way that people with cervicogenic headaches. These would be high-intensity multi-directional exercises.

What the therapists came upon here is that the key to neck-tongue syndrome may be in strengthening the neck.

Below what we will discuss strengthening the cervical neck structure with Prolotherapy injections into the cervical region that has been shown to work on its own in relieving patient symptoms.

Do cervical collars help?

We are going to go back to 1984 and a study published in the Journal of Rheumatology.(6) Here researchers discussed the use of cervical neck collars to help stabilize the neck-tongue syndrome patient’s neck and alleviate symptoms.

At our clinics, our patients discuss the use of cervical collars to help alleviate symptoms until Prolotherapy treatments have induced repair and strength to the cervical region.

Numb tongue, burning mouth, and other tongue pain from nerve impairment due to cervical instability

Ross Hauser, MD and Brian Hutcheson, DC discuss the nerves in the neck and face that affect tongue feeling and function, and when staying in prolonged positions can impair the nerves. The cervical instability one can experience during various movements and positions can cause painful symptoms like burning mouth or numb tongue, and difficulty speaking or moving the tongue.

In many cases of Burning Mouth Syndrome or numb tongue we would recommend a tag-team approach of Prolotherapy injections to strengthen the cervical ligaments to help restore cervical spine stability, and cervical curve realignment therapy through the use of specialized chiropractic care.

In almost all the cases of Burning Mouth Syndrome or numb tongue we have seen at Caring Medical, there has been some kind of dental work involved. Whether it’s a wisdom teeth being pulled or a crown or a cavity.

Burning tongue / Numb Tongue Syndrome

Problems with these nerves and cervical spine instability can also cause problems of  Numb Tongue Syndrome where half or more than half of the tongue feels numb tongue and often that occurs with motion.

If you have a tongue issue whether it’s numbness whether it’s pain, if you have difficulty moving it, you have already been to a neurologist in you’re not good results what can be an answer?

We can  sometimes find that under certain motion of the neck, as pointed out, loss of tongue sensation with movement, we find under examination that motion of the cervical spine is causing nerve irritation that is impacting the tongue function.

The basic message, if you get rid of the irritation of the C1 or C2 nerve roots by positional changes of the cervical vertebrae, or a diagnostic nerve block, and this alleviates your problems. Then a further exploration of your burning mouth and tongue problems and it cervical spine connection should explored.

A person with instability of the upper cervical spine, or C1-C2 (atlanto-axial) instability, a rapid rotation of the head can cause the symptoms of neck-tongue syndrome.  Although such treatments as utilizing a cervical collar, performing isometric neck exercises, and posture control, are important modalities in C1-C2 instability, they do not treat the root of the problem of neck-tongue syndrome.  They also provide only temporary relief.

It is our opinion that stabilization of the atlantoaxial facets is what is necessary to resolve neck-tongue syndrome. A more permanent solution option to consider is Prolotherapy. These regenerative injections directed at the weakened ligaments can stimulate repair of the subluxed, unstable atlantoaxial areas. Prolotherapy can help the symptoms of neck-tongue syndrome by stabilizing the excessive movement at the atlantoaxial facets.

Prolotherapy injections for Atlantoaxial instability

In 2015, Caring Medical published findings in the European Journal of Preventive Medicine investigating the role of Prolotherapy in the reduction of pain and symptoms associated with increased cervical intervertebral motion, structural deformity, and irritation of nerve roots.

Twenty-one study participants were selected from patients seen for the primary complaint of neck pain. Following a series of Prolotherapy injections, patient-reported assessments were measured using questionnaire data, including range of motion (ROM), crunching, stiffness, pain level, numbness, and exercise ability, between 1 and 39 months post-treatment (average = 24 months).

We concluded that statistically significant reductions in pain and functionality, indicating the safety and viability of Prolotherapy for cervical spine instability.(7)

Treatment of Neck-Tongue Syndrome at Caring Medical begins with a simple email to tell us about your pain challenges and your medical history. We will discuss if you are a candidate for our treatments. Get help and information from our Caring Medical staff.

1 Chu EC, Lin AF. Neck–tongue syndrome. BMJ Case Reports CP. 2018 Nov 1;11(1). [Google Scholar]
2 Gelfand AA, Johnson H, Lenaerts ME, Litwin JR, De Mesa C, Bogduk N, Goadsby PJ. Neck-tongue syndrome: a systematic review. Cephalalgia. 2018 Feb;38(2):374-82. [Google Scholar]
3Allen NM, Dafsari HS, Wraige E, Jungbluth H. Neck-Tongue Syndrome: An Underrecognized Childhood Onset Cephalalgia. Journal of child neurology. 2018 Apr;33(5):347-50. [Google Scholar]
4 Roberts CS. Chiropractic Management of a Patient With Neck-Tongue Syndrome: A Case Report. Journal of chiropractic medicine. 2016 Dec 1;15(4):321-4. [Google Scholar]
5 Niethamer L, Myers R. Manual therapy and exercise for a patient with neck-tongue syndrome: a case report. journal of orthopaedic & sports physical therapy. 2016 Mar;46(3):217-24. [Google Scholar]
6 Webb J, March L, Tyndall A. The neck-tongue syndrome: occurrence with cervical arthritis as well as normals. The Journal of rheumatology. 1984 Aug;11(4):530-3. [Google Scholar]
7 Hauser R, Steilen D, Gordin K The Biology of Prolotherapy and Its Application in Clinical Cervical Spine Instability and Chronic Neck Pain: A Retrospective Study. European Journal of Preventive Medicine. Vol. 3, No. 4, 2015, pp. 85-102. doi: 10.11648/j.ejpm.20150304.11


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