Cervical Vertigo

Cervical vertigo is a syndrome where individuals experience neck pain, dizziness, and imbalance. It is commonly seen in patients with cervical pathology. Vertigo has many vestibular and neurological causes as well. Therefore, it is especially important to rule out these causes before diagnosing cervical vertigo because the treatment is different for each condition.

In patients with cervical vertigo, intermittent neck pain and disequilibrium can be extremely debilitating. If you have this condition and it is affecting your daily life, read on further to find out what causes it and how it can be treated.

What Is Cervical Vertigo?

Cervical vertigo is a condition characterized by vertigo, intermittent neck pain, and disequilibrium. Each of these symptoms presents quite differently from those seen in other forms of vertigo.

Cervical vertigo can quickly begin to affect daily activities and quality of life. It is characterized by dizziness and neck pain. The episodes of dizziness can be so debilitating, that a person cannot drive, work, or maintain a livelihood.

Symptoms Of Cervical Vertigo

The two main symptoms of cervical vertigo are dizziness and neck pain. Other symptoms include disorientation, nausea, and vomiting. The duration of these symptoms can range from days to months, and even years. Here is a list of symptoms commonly seen in cervical vertigo:

Dizziness

This dizziness in cervical vertigo does not have that spinning quality where people feel they are turning. Instead, they have the sensation that the world around them is floating by. An episode of dizziness can last anywhere from a few minutes to a few hours. However, this dizziness is distinguishable from other causes as it does not come with ear fullness, tinnitus, or hearing loss.

Neck Pain

Intermittent neck pain is a common symptom of cervical vertigo. The neck pain can be triggered by certain head movements and, as a result, many patients have a “guarded neck” posture.

Disorientation

People with cervical vertigo frequently feel disoriented. They look and feel unsteady, and are often lightheaded. Some people may even be clumsy or appear uncoordinated with their movements.

Nausea And Vomiting

The constant dizziness can easily cause a person to become nauseous. Nausea and vomiting are not direct symptoms of cervical vertigo, but are secondary to vertigo. This means that these symptoms do not occur directly due to vertigo but because of it.

Visual Symptoms

Visual symptoms like the rapid movement of the eyes and visual fatigue occur because of the dizziness as the eyes are constantly trying to adjust to vertigo.

Cervicalgia / Neck Pain

Cervicalgia is also known as neck pain, which is an all-too-common, unpleasant pain. Read here to learn the symptoms, diagnosis, and treatment options. We will discuss other causes for cervicalgia. What symptoms are associated with cervicalgia? How is cervicalgia diagnosed? What are the treatment options for cervicalgia? Cervicalgia is a medical term used to describe neck pain. It is very common and affects approximately 2/3 of the population at some point in their life. Cervicalgia is the 4th major cause of disability. Risk factors include injury, prior history of neck and musculoskeletal pain, jobs that require a lot of desk work, low social support, job insecurity, physical weakness, and poor computer station setup.

Read More About Cervicalgia / Neck Pain

Gastrointestinal (GI) Problems

Gastrointestinal (GI) problems can be debilitating comprising one’s wellbeing and ability to confidently engage in life. Symptoms vary and can include nausea, bloating, constipation, diarrhea, delayed motility, abdominal pain, irritable bowel-like symptoms, heartburn, and reflux. GI problems can be due to structural and functional problems within the gut itself. Examples include hiatal hernia and bacterial overgrowth. Less appreciated is the fact that many patients with Craniocervical instability (CCI) can also have significant GI problems. Regrettably, many of these patients undergo extensive, costly GI evaluations only are told that their examinations and studies are normal. This can be extremely frustrating. For these patients…

Read More About Gastrointestinal (GI) Problems

Left Arm Numbness

Treatment depends upon the underlying cause of the arm numbness. Left-arm numbness is a warning sign that requires attention. As noted above unexplained numbness requires immediate attention. At the Centeno-Schultz Clinic, we are experts in the treatment of left-arm numbness due to cervical nerve irritation, cervical stenosis, thoracic outlet syndrome, and peripheral nerve injuries. When appropriate first-line treatment should involve conservative care including physical therapy and stretching. Steroid injections should be avoided as they are toxic to orthopedic tissue and can accelerate damage. Surgery for Cervical Stenosis and Thoracic…

Read More About Left Arm Numbness

Neck Pain And Dizziness

Our body’s balancing system is compromised of three separate systems that work closely together to keep the body in balance: the eyes, inner ear, and upper cervical spine. The upper cervical spine contains and processes information about your position in space and communicates this information to your eyes and inner ears via nerves. There is a constant highway of electrical signals between the cervical spine, inner ear, and eyes that keep us upright, make us aware of our position and enable us to walk, move and run. This balancing system requires the inner ear, eyes and cervical spine to be operational…

Read More About Neck Pain And Dizziness

Neck Spasms

Typically they involve the entire neck but may be more intense on one side leading to an involuntary rotation of the neck.  Neck spasm and neck pain are common as 2/3rd of all people will experience it at some time.  It occurs most often during middle age with women being affected more than men. muscle tightness.  The neck muscles may feel hard or knotted to the touch.  When severe it may be difficult to bend or rotate the neck due to pain and muscle tightness.  The pain may extend down into the shoulders or up into the base of the skull with the onset of a headache.

Read More About Neck Spasms

Pain At The Base Of The Neck

Pain at the base of the neck is the fourth most common cause of disability. It is important to understand the cause of the pain because it determines what treatment you need. While most pain at the base of the neck resolves without treatment, 50% of patients tend to have lingering symptoms and need to address the specific cause. 

Read More About Pain At The Base Of The Neck

Common Causes Of Cervical Vertigo

What causes cervical vertigo? There is no epidemiological predisposition for cervical vertigo as anyone can develop this condition. However, it is more commonly seen in those who have a recent history of trauma, arthritis, cervical spondylosis, recent neck surgery, and herniated discs. Here are some causes of cervical vertigo.

Trauma

After a traumatic incident, especially in whiplash accidents and motor vehicle accidents, cervical vertigo can develop. Rapid acceleration and rapid deceleration can lead to decreased range of motion of the neck. 

This results in whiplash-associated disorders (WAD) that originate from the cervical spine due to hyperextension of the ligaments. Cervical vertigo is frequently seen in WAD due to the shearing forces acting on the nerves, ligaments, and arteries.

Cervical vertigo is a complication that can occur after cervical intervertebral disc surgery. This is prevalent even ten years after surgery and is common in people who have had surgery for degenerative disc disease. It happens due to damage to the vascular supply in the cervical area (1).

Arthritis

Arthritis is an inflammation of the joints which gradually wears down the vertebrae. This puts pressure on the joints, nerves, and arteries. Compression of the spine, the nerves, and the arteries can lead to inappropriate signals being sent to the brain, ultimately leading to cervical vertigo. Another complication of arthritis that presents with cervical vertigo is Barre-Lieou syndrome.

Cervical Spondylosis

Cervical spondylosis is the breakdown of the bones and intervertebral discs in the neck. As there is an increased formation of bone and herniated discs, the arterial supply is compromised which causes cervical vertigo.

Arterial Compression

Any cause of arterial compressions like vertebral artery at the atlantoaxial level when the head rotates, tumors, and cord compression can also lead to cervical vertigo. Therefore, it is particularly important to assess the arterial supply in the cervical region to diagnose cervical vertigo.

Common Treatment Options

The treatment of cervical vertigo depends on the cause. However, in general, here are a few common conservative treatment options for cervical vertigo.

Improved Posture And Ergonomics

Improved posture and ergonomics mean sitting and standing while maintaining the natural curvature of the spine. Avoid awkward head positions, sudden movements like hyperextension or hyperflexion of the spine, and positions that can worsen cervical vertigo.

Pros

• Ideal for cervical vertigo that is affected or caused by posture and position
• Can prevent future cervical spinal degeneration

Cons

• Needs to be coupled with other treatments like physical therapy
• Takes a while to work
• Does not work in all cases of cervical vertigo

Medication

Since people with vertigo experience intermittent cervical neck pain, medications like analgesics can be highly effective at reducing pain and inflammation. In patients with painful and frequent neck spasms accompanying their cervical vertigo, muscle relaxants like cyclobenzaprine can reduce pain and stiffness.

Another class of medications that are highly effective in reducing dizziness are anti-dizziness drugs like Cinnarizine and antihistamines. These medications reduce the histamine in your brain and ear thus improving blood flow in the inner ear and reducing dizziness

Pros

• They provide immediate relief
• Reduce inflammation

Cons

• The anti-dizziness drugs can make you drowsy
• These medications do not treat the cause of the pain and dizziness

Physical Therapy

Physical therapy includes various exercises that focus on improving the range of motion of the neck. The smaller muscles of the neck are stretched and strengthened during these exercises. These muscles are not usually targeted by general neck exercises.You need a physical therapist to target these smaller muscles.

Pros

• Improves overall posture and strength of the cervical spine

Cons

• Will not eliminate dizziness but can be effective in relieving any nerve entrapment that is causing the dizziness. 
• Must be used with caution in those with neurovascular causes

Why Cervical Vertigo Is Hard To Diagnose

Vertigo has many causes. Visual, auditory, spatial, and neurological causes; all can cause vertigo. Doctors have to differentiate cervical vertigo from other forms of vertigo. And while neck pain is present in cervical vertigo, it may not also be present during the early stages.

Primary care doctors must do extensive eye, ear, and neurological tests to determine what is causing the dizziness.

Often, certain signs are masked if a person has been experiencing vertigo for several days. In the face of injury, the presence of damage to multiple structures can also make the diagnosis difficult.

Here are some conditions that can present as cervical vertigo

• Ear infections
• Benign positional vertigo
• Labyrinthitis
• Tumors in the brain
• Migraine
• Multiple sclerosis
• Stroke
• Meniere’s disease
• Meningitis
• Herpes simplex encephalitis

Diagnosing Cervical Vertigo

The diagnosis of cervical vertigo is one of exclusion where doctors will check every other cause before finally confirming cervical vertigo. A doctor will complete a series of tests to rule out any vestibular and neurological causes of vertigo before finally diagnosing cervical vertigo.

Patients must usually undergo multiple physical exams, an extensive battery of tests, and imaging modalities like magnetic resonance angiography (MRA), computed tomography angiography (CTA), or digital subtraction angiography (DSA). The diagnosis also depends on the clinical experience of the examining physician.

New Medical Approaches For This Condition

When conservative treatments like analgesics, physical therapy, and anti-vertigo medicine do not work, newer medical approaches can be used to treat cervical vertigo. Here are some common new-age treatments:

• Cervical Facet Injections
  
  Cervical facet injections are injections with anesthetic given into the cervical area posteriorly over the facets. These injections can be given with or without steroids and they block the pain by reducing inflammation of the cervical joints. 
  
  Steroids are usually avoided in the cervical area due to their side effects. Cervical facet injections are safer and better than intra-articular injections since the chance of hitting a vertebral artery is less with the former. 

• PRP Injections
  
  Another novel treatment approach for cervical vertigo is Platelet-rich plasma (PRP) injections. Here, a patient’s own platelet-rich plasma is injected into the affected area. This plasma aids in tissue regeneration as it stimulates the recruitment, growth, and differentiation of cells along with growth factors and proteins that are produced by the platelets. 
  
  Platelets can also regulate the inflammatory response and so they alter the pain pathway. 

• Stem Cell Therapy
  
  Stem cell therapy is a form of therapy where the patient’s bone marrow cells are used to restore the damaged tissue and modulate the inflammatory response in cervical vertigo. 
  
  The microenvironment of the stem cells plays a huge role in determining the differentiation of the stem cells before they are injected. This therapy requires highly skilled staff and laboratories to ensure it is successful. 
  
  At Centeno-Schultz, we have a state of the art lab that processes these stem cells before they are injected.

Don’t Let Any Condition Get In The Way of Living Your Best Life

Cervical vertigo can be managed and treated quite well, especially if it is diagnosed promptly.

At Centeno-Schultz, we combine conservative treatment and new medical treatments personalized to each patient. This includes cervical facet injections, PRP, and bone marrow-derived stem cells. These highly specialized procedures are only offered at Centeno-Schultz’s clinics because they require extensive training and experience.

You are one step closer to treating your cervical vertigo. Make an appointment with us today!

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Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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Other Resources for Cervical Vertigo

References

1. Hermansen A, Peolsson A, Hedlund R, Kammerlind AS. Balance problems and dizziness after neck surgery – associations with pain and health-related quality of life. Physiother Theory Pract. 2020;36(10):1145-1152. doi:10.1080/09593985.2019.1571137