A medical mystery: “How could my problems be caused by cervical neck instability when I don’t have any neck pain?”
Ross Hauser, MD.
People with many symptoms and conditions related to problems of cervical spine instability often consider themselves medical mysteries. Among the mysteries are their questions, “How could my problems be caused by cervical neck instability when I don’t have any neck pain?”
In my opinion, the number one reason many people with suspected compression in the cervical spine do not get their ailments diagnosed correctly, such as a heart rhythm problem, a lung problem, an eye condition, brain fog, horrible body fatigue or tachycardia, is that the doctors aren’t diagnosing these problems as being related to the neck because the person doesn’t have a lot of neck pain.
If someone has neck pain and they have skipping heartbeats or similar symptoms, the doctor might think maybe it’s from the neck. But when you don’t have neck pain and you have head pressure the doctor is not going to suspect that it is a problem coming from the neck. I want to explain, how can this be.
Please see my related articles:
- Neurologic-like symptoms and conditions of Cervical Spine Instability
- Dysautonomia, POTS, and the hEDS patient with a long list of symptoms and conditions
- Symptoms and conditions of cervical spine compression causing internal jugular vein stenosis
- Symptoms and conditions of Craniocervical and Cervical Instability
- Can cervical spine instability cause cardiovascular-like attacks, heart palpitations, and blood pressure problems?
- How neck pain and cervical spine instability cause nausea, gastroparesis, and other digestive problems
- Cervical spine instability and digestive disorders: Indigestion and irritable bowel syndrome caused by cervical spondylosis
The cervical neck ligaments are not stretched, therefore you have no neck pain. But you can still have neck problems created by neck muscle tightness.
What does this mean? When a person develops cervical spine instability, a degenerative neck structure, cervical myelopathy, or cervical spine dysstructure, the ligaments become loose and allow the vertebrae to wander. However, to stop these wandering bones from wandering, the muscles will tighten and spasm as they try to hold everything in place. What is happening is that the muscles are stiffening and tightening to prevent excessive bone movement.
Here is the neck pain part.
With the muscles holding the bones in place, the ligaments are not being stretched. When the ligaments are not being overstretched there is little or no neck pain.
How does this work?
The nerve endings in the ligaments are the primary pain sources. When the ligaments are stretched, that stretching sensation transmits pain messages to the brain through the nerve endings of the ligaments.
A slide from the video:
A person’s symptoms can be due to cervical dysstructure / instability but do not include neck pain/.
- People with symptoms that are related to neck instability may lie down for many hours a day. This minimizes the force on the neck, but the body still has compensatory mechanisms to temporarily stabilize the neck: joint swelling and muscle tension.
- Primary structural problems, not in the ligaments but in a malalignment, subluxation, or simply wandering vertebrae or horrific arthritic cervical curve.
- Severe compression or kinking of a blood vessel, vagus nerve degeneration, cervicovagopathy, and severe pathophysiology.
In the image below:
Various fluid flows can be compromised by ligamentous (ligament weakness causing) cervical instability
- A – Venous: especially internal jugular veins in the anterior neck.
- B – Carotid sheath: Arterial: Primarily vertebral and posterior neck
- C – Cerebrospinal fluid vertebral misalignments especially in the atlas.
A person can have malrotation of the vertebrae that causes symptoms but not neck pain itself. These are the three mechanisms that primarily can cause you to have systemic symptoms but not neck pain.
The image below is used as a reference to help visualize the problems Dr. Hauser discusses below. The caption of this image reads:
View looking up showing the position of the atlas and carotid sheath contents to the jugular and carotid foramen.
Atlas misalignment especially displacement anterior (to the front) can kink the carotid sheath contents, particularly the carotid artery internal jugular vein, and vagus nerve.
If a person has compression of the jugular vein, the jugular vein goes through the jugular foramen, what also goes through that foramen hole is the glossopharyngeal nerve, the spinal accessory nerve, and the vagus nerve. If somebody had malrotation of the atlas, they could have compression of all those structures or because of a forward head posture, again, the atlas could go forward and then that could cause compression of the jugular vein. When you get compression of the jugular vein you are going to end up having head pressure, your brain is not going to work right, and you can have terrible brain fog.
The same thing can occur with changes in the neck structure where the vertebral arteries, form the basilar artery and t its branches that supply all the blood to the back of the brain. Anybody who turns their head and all of a sudden they get really dizzy or they get vertigo, their heart may race. Usually, this relates to these blood vessels getting compressed in the neck.
For more on this topic, please see my article: Treating Vertebrobasilar Insufficiency, Vertebrobasilar Artery Insufficiency, Rotational Vertebral Artery Occlusion Syndrome, or Bow Hunter Syndrome.
Transcranial Doppler exam
A way to diagnose compression of the arteries is through Transcranial Doppler Examination. The images show the examination in two positions.
The ultrasound probes measure the blood flow in the brain. We have the patient hold different head positions to assess if there are major changes in the blood flow caused by cervical spine instability and different problems in their neck. We can do the same examination of the carotid arteries in the front of the neck. Those arteries supply 70% of the blood flow to the brain. but mostly the front part and we can measure the blood flow in those arteries.
Cerebral spinal fluid blockage
In the image below the caption reads Blockage of cerebrospinal fluid flow from upper cervical instability. Ligament damage at the level of the atlas C1 or axis C2 can block cerebrospinal fluid flow and cause the toxic accumulation of substances in the brain.
You can get systemic symptoms when there’s obstruction of the cerebral spinal fluid. Obstruction can come in the form of osteoarthritis narrowing the spinal canal with the overgrowth of bone. Add to this cervical spine instability and the combination of one or the other can block cerebrospinal fluid flow which can increase brain pressure and give you head pressure. I call this, clogged brain toilet.
I use the analogy of a clogged toilet to describe the problems of a brain that is not draining its toxic fluids and replenishing its clean fluids properly. The problems that these waste products from brain neuron activity may cause and what happens when these fluids back up and cannot be flushed out of the brain are discussed at length in my article Brain Toilet Obstruction.
The clogged brain toilet
The slide reads: Obstruction of arteries and veins both into and out of the brain from cervical instability and cervical dysstructure ultimately results in an accumulation of cerebrospinal fluid in various parts of the brain including the frontal lobe which destroys brain neurons and tissue. This is one explanation for severe brain fog in mental decline in people with upper and lower cervical instability
When the brain can’t drain or the fluid flow in the brain is slowed, which can be an obstruction of the cerebral spinal fluid. In the above example, the jugular vein is getting compressed which causes increased cerebrospinal fluid in the frontal area of the brain. The frontal lobe is involved in detailed problem-solving and “good behavior” knowledge of right and wrong. The frontal lobe therefore also inhibits “bad behavior.” When you get cerebrospinal fluid accumulates in the frontal lobe, the person can have anxiety, they can have difficulty working on simple tasks, display frustration, and even experience rage.
Potential symptoms from internal jugular vein compression
Headache, head pressure, eye pain, dizziness, anxiety, visual snow, distorted vision, afterimages, seasickness feeling, unstable visual field, depression depersonalization, brain fog, focusing issues, and hormone imbalance.
We hope you found this article informative and that it helped answer many of the questions you may have surrounding the problems of cervical spine instability and the myriad of symptoms it may cause. 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.