Cervicogenic Dizziness - An Overview

Introduction

The spinal cord is made up of 24 vertebrae or bones. The cervical spine present in the neck region consists of seven bones close to the skull that are separated from each other by intervertebral discs. These discs enable free movement of the spine and act as shock absorbers. Nerves that carry messages from the brain to various parts of the body run along the spinal cord. The muscles around the spinal cord are involved in movement and communication between the brain and the body.

What Is The Difference Between Vertigo And Cervical Vertigo?

Vertigo is a symptom and not a condition in which a person feels that the surrounding around them is moving or spinning though they remain stationary. Cervical vertigo is a type of vertigo due to a neck injury or inflammation.

Who Are Prone To Cervicogenic Dizziness?

The following people are prone to cervicogenic dizziness:

• Those with severe head injuries.

• Cervical spondylosis (age-related wear and tear of the spinal disks in the neck).

• Herniated disc (a condition in which the soft disc in the spine pushes through a crack in the tough outer covering).

• Whiplash injuries (a neck injury due to forceful, rapid front and back movement of the neck).

• People who sit with poor posture and bend too much to look at electronic gadgets (called text neck) pressurize the arteries on the neck causing cervical vertigo.

What Causes Cervicogenic Dizziness?

Cervicogenic dizziness is caused by:

• Obstruction of arteries in the neck as a result of hardening (atherosclerosis) or dissection (tearing) of these arteries.

• Dizziness occurs when there is a disturbance in the blood flow to the inner ear or brain stem (lower portion of the brain).

• Arthritis (swelling and pain in one or more joints), surgery, and trauma could also affect the blood flow in the neck.

• Proprioceptors are sensory receptors that receive stimuli or signals from within the body that responds to position and movement. The muscles and joints present in the neck have proprioceptors that signal about the orientation and head movement to the brain and the vestibular apparatus (parts of the inner ear that maintain balance). When this mechanism is disrupted, receptors are unable to communicate the information to the brain causing dizziness and other sensory malfunctions.

• Muscle strain.

• Stress and anxiety can exaggerate the symptoms.

What Are The Symptoms Of Cervicogenic Dizziness?

The symptoms are as follows:

• Dizziness or instability which gets worse during head movements or when in a particular neck position for a long duration.

• Dizziness occurs as a consequence of neck pain, stiffness, or decreased range of motion. It can also be followed by a headache at the back of the head and which gets exaggerated by head movements and not by physical movements. Dizziness decreases with a decrease in neck pain. The symptoms last from a few minutes to hours.

• Inability to maintain a straight and upright posture.

• Vision difficulties such as rapid eye movement, sense of movement even if stationary, unable to maintain a fixed look on moving objects.

• Different or strange walk.

• Nausea and vomiting.

• Headaches that feel like a ring around the head, the sensation of the head pressing against the front of the skull.

• Tightness or discomfort in the neck.

• Severe headache (migraine) that causes sensitivity to light and noise.

• Trouble concentrating.

• Ringing in the ears or ear pain.

What Conditions Can Overlap With Cervicogenic Dizziness?

Cervicogenic dizziness can overlap with inner ear problems like:

• Vestibular Neuritis: It is a condition that affects the nerve that connects the inner ear to the brain called the vestibular nerve causing prolonged vertigo.

• Labyrinthitis: Labyrinthitis is the inflammation of the labyrinth present in the inner ear affecting hearing and balance.

• Benign Paroxysmal Positional Vertigo (BPPV): It is the most common type of vertigo that affects the inner ear and creates a false sensation of movement or spinning.

• Acoustic Neuroma: Acoustic neuroma is a benign tumor that develops on the vestibular (responsible for balance and hearing) or auditory (cochlear) nerves leading from the inner ear to the brain.

The above conditions have to be ruled out before confirming the diagnosis of cervicogenic dizziness.

How To Diagnose Cervicogenic Dizziness?

There is no particular test to diagnose cervicogenic dizziness. A complete history and medical evaluation are required to rule out other conditions as these symptoms can imitate other conditions that cause dizziness. Detailed assessment of the neck is mandatory. Diagnosis of exclusion can be difficult as it requires expertise and a good knowledge of the tests involved in the diagnosis to compare with other conditions. Other diagnostic methods include:

• Physical Examination: The presence of nystagmus (rapid, repetitive, and involuntary movement of the eyes) on head positioning indicates cervicogenic dizziness.

• Magnetic resonance imaging (MRI) of the neck.

• Magnetic resonance angiography (MRA).

• Vertebral Doppler ultrasound.

• Vertebral angiography.

• Flexion (bending) extension X-ray of the cervical spine.

• Tests to measure brain and spinal cord pathways in the nervous system are called evoked potential tests.

• Vestibular test battery to eliminate vestibular or inner ear conditions.

How To Treat Cervicogenic Dizziness?

The first step in treatment involves treating the underlying medical condition. Neurologists (experts in treating diseases of the brain, neck, and spinal cord) treat cervicogenic dizziness. Various treatment modalities include:

• Conservative Management: This includes gentle movements of the neck, neck exercises, and maintaining proper posture and neck position.

• Medications: Medicines are prescribed to reduce neck tightness, pain, and dizziness. Muscle relaxants such as Tizanidine and Cyclobenzaprine, analgesics (painkillers) such as Ibuprofen, Tramadol, Acetaminophen, and anti-dizziness drugs such as Scopolamine and Antivert may be prescribed.

• Physical Therapy: Physical therapy exercises work on improving balance, stability, muscle strength, coordination, and the neck’s range of motion. These exercises can relieve the symptoms of cervicogenic dizziness but cannot terminate dizziness. Proper stretching exercises can minimize the symptoms. If needed, the physician might refer the patient for chiropractic (a medicinal technique based on the diagnosis and manipulative treatment of misalignment of the joints, especially those involving the spinal cord) adjustment of the neck and the spine.

• Vestibular Rehabilitation: It includes exercises focused to relieve dizziness and to improve balance. The exercises may involve training in eye movements, neck movements, balance, and walking.

What Parts Must Be Focussed In Physical Therapy Of Cervicogenic Dizziness?

The following body parts must be focussed in physical therapy to relieve the symptoms:

• Muscles are present directly underneath the skull.

• Neck muscles.

• Muscles from the neck to the shoulder and then down to the shoulder.

• Muscles on the side of the neck.

• Pectoral muscles (muscles that connect the front of the chest with the bones of the upper arm and shoulder).

How To Prevent Cervicogenic Dizziness?

Though certain conditions such as trauma are unavoidable, cervical vertigo can be prevented by following frequent neck exercises to keep them strong and to reduce the pressure and the load on the cervical disks. Proper posture can prevent wear and tear of intricate structures in the neck. Regular massages and warm compresses can help to relax the area and reduce the symptoms.

Conclusion

Dizziness can affect daily activities. The outcome of cervicogenic dizziness is good and the quality of life can be improved by managing the symptoms through appropriate management. The symptoms of dizziness should not be ignored, and a physician must be consulted immediately. Self-medication should not be followed as the symptoms imitate other conditions that cause dizziness.