Vertigo and Dizziness
Cervical Vertigo
Cervical Vertigo, also known as cervicogenic vertigo or cervicogenic dizziness is a controversial entity. There is evidence that it is a distinct disorder but there is no agreed upon pathophysiology, reliable test, or diagnostic criteria. Reliable and well established tests support an alternative diagnosis in almost all patients with vertigo. [1] In centres with advanced capabilities for assessing vertigo, cervical vertigo probably makes up about 1% of all cases. However, in settings of whiplash, post-traumatic dizziness is very common.
All clinical studies on the condition have three major weak points: inability to confirm the diagnosis, no specific laboratory test, and unexplained discrepancy between those with
severe neck pain with no vertigo and those with moderate neck pain with severe vertigo.Cite error: Closing </ref> missing for <ref> tag Manual therapy seems to be effective.[2] There is often a disturbance in vestibulospinal control of optokinetic pursuit: Eye pursuit normal with static head, abnormal with head rotation.
“…cervical vertigo results from altered somatosensory input into the vestibular nuclei from the proprioceptors of the upper cervical region…[there is a] sensory mismatch between vestibular and cervical inputs” [1]
The neural mismatch model describes a mismatch between expected and actual neck movement From neck pain/stiffness, inducing motion sickness. [3]
Migraine Associated Cervicogenic Vertigo
Vestibular migraine is the second most common cause of vertigo after BPPV. Migraine could be a link between cervical pain and vertigo through connections between the vestibular and trigeminal nuclei.[1]
Assessment
History
- Pain in back of neck, radiates temporo-parietally, may only be present with palpation
- Symptoms worse with neck pain and neck movement
- Symptoms better with interventions that relieve neck pain
- Vertigo lasts minutes to hours
- History of neck injury
Examination
- Reproducible vertigo with neck manipulation
- Tender suboccipitally, C1 and C2 transverse processes
- Tender C2 and C3 spinous processes
- Tender myofascial structures
- Upper C-spine range of motion
- No definitive diagnostic test
Treatment
Both Mulligan (in the form of cervical SNAGs) and Maitland mobilisations appear to be beneficial.[2]
References
- ↑ 1.0 1.1 1.2 Li & Peng. Pathogenesis, Diagnosis, and Treatment of Cervical Vertigo. Pain physician 2015. 18:E583-95. PMID: 26218949.
- ↑ 2.0 2.1 Li & Peng. Pathogenesis, Diagnosis, and Treatment of Cervical Vertigo. Pain physician 2015. 18:E583-95. PMID: 26218949.
- ↑ Brandt & Huppert. A new type of cervical vertigo: Head motion-induced spells in acute neck pain. Neurology 2016. 86:974-5. PMID: 26826207. DOI.
