Cervicogenic dizziness is characterized by the presence of imbalance, unsteadiness, disorientation, neck pain, limited cervical range of motion (ROM), and may be accompanied by a headache. Movements of the head and neck may also aggravate symptoms. The symptoms of cervicogenic dizziness can last from several minutes to several hours. It is not a common diagnosis, and the patient may also feel generalized sensations of imbalance. This imbalance may also be worsened with ranges of motion in the head and neck, or movement in the environment.
As portal-of-entry healthcare providers, doctors of chiropractic frequently evaluate patients presenting with complaints of dizziness. Although often benign, dizziness can be caused by serious, emergent conditions, and this requires that healthcare providers pay close attention and look for red-flag signs and symptoms, including neurologic dysfunction and alterations in cognitive function.
The clinician must differentiate a central (serious) cause of dizziness/vertigo versus a peripheral (more likely benign) cause of dizziness/vertigo. Dr. Mark Pfefer, director of research at Cleveland University-Kansas City (CUKC) was part of a team assessing the effects of chiropractic care on impaired balance, chronic pain, and dizziness in older adults.
Dizziness is a common complaint among older adults, and in this 2009 study, it was determined that chiropractic care was often helpful in lessening the sensations of dizziness.
Pfefer also co-authored a case study in which a patient with cervicogenic dizziness combined with cervicogenic headache responded well to a chiropractic intervention. It is likely that many patients with dizziness who respond well to chiropractic care are actually suffering from cervicogenic dizziness, which means that cervical spine (neck) joint dysfunction may be contributing to the dizziness.
“After potentially serious causes are ruled out, patients and primary care physicians should consider a trial of care involving a manual therapy approach, especially from a well-trained, evidence-based chiropractor or physical therapist, as patients with benign dizziness will often improve with this treatment,” Pfefer said.
Numerous medical conditions exist that present with a patient complaint of dizziness, including vestibular, cardiovascular, metabolic, neurological, psychological, vision problems, and medication side effects. As early as 1955, researchers Ryan and Cope described a type of dizziness syndrome consisting of imbalance and disorientation in people with many different neck diagnoses, including cervical trauma, cervical spondylosis or cervical arthritis. The term Ryan and Cope used to describe this condition is “syndrome cervical vertigo.” The term cervicogenic dizziness (abbreviated CGD) is the appropriate and current terminology, as true spinning vertigo is rarely associated with neck- or cervical spine-related dizziness (as referenced in Reiley et al, 2017).
Cervicogenic dizziness
No single diagnostic test exists to confirm that dysfunction in the cervical spine is the cause or origin of the dizziness episodes. A diagnosis of CGD is one of exclusion, requiring a comprehensive history and evaluation to rule out other medical diagnoses that could contribute to the patient’s episodes of dizziness.
Neck injuries such as acceleration-deceleration injuries or trauma, or head injuries such as concussion, can also injure the brain or inner ear. As a result, it is imperative that the healthcare professional determine the appropriate clinical, laboratory, and imaging tests required for proper medical inclusion and exclusion diagnostic criteria.
Dr. Anne Maurer, an instructor at CUKC, says dizziness is a relatively common and disabling disorder seen in clinics that provide manual therapy and chiropractic care.
“Although there is debate regarding the diagnostic criteria for cervicogenic dizziness, pain and other noxious stimuli may lead to changes in the sensory input to the cervical (neck) spine, resulting in a sensation of dizziness,” Maurer said. “The cervical proprioceptive system is related to the vestibular system in both anatomical proximity and physiologic functions. Appropriate treatment by properly trained clinicians can often be a simple and effective solution to the patient’s complaint.”
There is currently a need for further investigation, research, and the development of a thorough, stepwise process for determining the inclusion and exclusion criteria of the differential diagnoses of cervicogenic dizziness. CUKC is undertaking additional studies to refine assessment and evaluate outcomes in older patients with dizziness, neck pain and headaches.
We welcome collaborative researchers who are interested in this topic. Please feel free to contact Pfefer at mark.pfefer@cleveland.edu.
