Craniocervical instability (CCI) occurs when the supportive muscles and ligaments in the upper cervical spine become ‘loose’ or ‘lax’.
The importance and complexity of the vagus nerve is highlighted in its name. Vagus is the Latin word for ‘wandering’ and, as the name suggests, the vagus nerve travels widely throughout the body, resembling the root system of a tree.
As the largest cranial nerve, the vagus nerve is a very important ‘communication highway’, carrying thousands of essential signals to and from the brain and body.
For example, the vagus nerve is vital in sending sensory information for seeing and hearing. It is also critical for maintaining the normal balance (homeostasis) of integral bodily functions such as heart rate regulation, digestion, respiration, mood control, and immune health.
If the vagus nerve becomes compressed as a result of CCI, it will be unable to properly communicate the signals required for homeostasis. This will result in an imbalance in the body’s systems and daily functions, potentially resulting in symptoms that will have an impact on overall wellness.
This article will explain how CCI can affect the vagus nerve, the symptoms associated with it, and potential treatment options.
How Craniocervical Instability Causes Vagus Nerve Compression
With CCI, an injury or underlying medical condition has caused the strong muscles and ligaments that support the neck to become lax and unstable. This allows for excessive segmental motion in the upper cervical region (where the vagus nerve originates at).
As these supporting ligaments loosen, the vertebral discs in the spine might move beyond their usual range, becoming unstable and hypermobile. CCI particularly affects the C1 and C2 vertebrae, which are located just below the skull and help to support the head. This is also described as the craniovertebral junction (CCJ).
As a result, if the hyper-mobile vertebrae of CCI come into direct contact with the vagus nerve, they may compress, pinch it or irritate.
Additionally, swelling and inflammation associated with an underlying condition can cause vagus nerve irritation. Compression or irritation of the vagus nerve can cause severe pain in the neck and shoulders, or induce headaches, dizziness, and brain fog.
Additionally, since this nerve is complicated and wandering in nature, many other crucial bodily systems may also be disrupted if it sustains damage.
The vagus nerve is clearly a significant sensory network that is critical for transmitting and receiving vital information that maintains homeostasis in a variety of bodily systems. Specifically, the vagus nerve communicates ‘rest and relaxation’ signals, which counteract the ‘fight or flight’ response to stress or danger.
In particular, it sends signals that lower the heart rate and blood pressure and normalizes breathing patterns. It will also send signals to promote digestion, induce feelings of calm, and boost immune function.
Consequently, a compressed or irritated vagus nerve can block the messages that generate the ‘rest and relaxation’ signals to the body. This will cause an overstimulation of the body’s ‘fight or flight’ response, causing symptoms of anxiety, elevated heart rate, and chronic heartburn.
Chronic Neck Pain and Craniocervical Instability
The root cause of any chronic neck pain can be difficult to determine, as some conditions may produce similar symptoms. There are, however, some distinguishing differences when it comes to the pain associated with CCI.
CCI results in excessive movement between the head and neck. This can cause damage to the neck’s upper cervical facet joints, vertebral discs, nerves, and blood vessels.
The location and severity of pain typically depend on the element of instability and movement. In general, the greater the instability, the more severe the symptoms. Painful CCI symptoms include:
Headaches can become persistent and debilitating. This is brought on by the constant strain and instability of CCI, which damages the upper neck joints, muscles, and tendons.
- Painful or heavy head
A constant and painful head is often described as the head feeling too heavy for the neck, or the head feeling difficult to support. This is due to the lax ligaments’ inability to provide appropriate head and neck stability.
- Neck pain
Chronic (long-standing) neck pain in CCI is typically felt at the base of the skull or upper neck. It is often aggravated by bending the neck forward and through rotation. Pain may also radiate to the top of the head, forehead, or behind the eyes.
Causes Of Craniocervical Instability
Although not always possible, it is helpful to have an understanding of how and when the neck pain or injury first occurred.
Common causes of CCI are direct trauma or medical conditions that provoke the muscles and ligaments in the neck to become overstretched or weakened.
Examples of trauma include whiplash from contact sports, motor vehicle accidents, or over-manipulation from chiropractors. These cause overstretching and weaknesses in the muscles and ligaments, which lead to neck instability.
- Inflammatory Conditions
Rheumatoid arthritis, lupus, and scleroderma are chronic inflammatory conditions that result in inflammation, injury, and pain. These conditions inflict damage and degeneration throughout the neck’s bones and joints. Surrounding muscles and ligaments are subsequently placed under great strain and can become weakened, increasing the risk of CCI.
- Connective Tissue Disorders
A connective tissue disorder, such as Ehlers-Danlos Syndrome (EDS), directly affects the body’s connective tissue. EDS causes ligaments to become lax, allowing joints to become very flexible and possibly decreasing stability.
If the ligaments of the craniovertebral junction become lax or compromised from a connective tissue disorder, it can cause CCI.
- Congenital Conditions
Additionally, some congenital conditions such as Dwarfism or Down’s Syndrome can also increase the risk of CCI. This is often a result of malformations of neck structures or increased flexibility seen in the muscles and ligaments.
How Vulnerable Is The Vagus Nerve To Compression Through CCI?
We often refer to the vagus nerve as a single nerve. However, it is actually a pair of nerves that travel down each side of the neck, which then branch out into the chest and abdomen. The vagus nerve sits directly at the craniovertebral junction just below the skull, and travels closely down both sides of the vertebrae.
CCI occurs at the craniovertebral junction, and the overstretched ligaments are not able to adequately stabilize the C1 and C2 vertebrae. This causes excessive side-to-side (lateral) movement of the vertebrae, and the vagus nerve is vulnerable to direct compression due to its close proximity.
Depending on the severity of the instability, the vagus nerve may be compressed on either side of the neck.
Parts Of The Body Affected By Vagus Nerve Compression
The vagus nerve plays an important role in the autonomic nervous system. The autonomic nervous system is the body’s control center for balancing and regulating bodily functions, such as breathing, circulation, and hormones.
Subconsciously, the brain activates our autonomic nervous system through two sensory nerve feedback systems; the fight or flight (sympathetic) nervous system and the rest and relaxation (parasympathetic) nervous system.
Importantly, the vagus nerve is the main sensory nerve for the parasympathetic nervous system. When functioning normally, the vagus nerve sends signals to the brain and body that it’s time to rest, relax, and digest.
It will stimulate the digestive system, slow the heart rate and breathing, reduce inflammation, and ease anxiety by boosting the release of calming chemicals.
Consequently, CCI that has compressed the vagus nerve will cause a blockage of the parasympathetic nervous systems’ key messages. This restricts the body’s ability to appropriately enter a state of rest and relaxation and creates imbalances in the autonomic nervous system.
This imbalance is described as autonomic dysfunction and results in an over-activation of the fight-or-flight sympathetic nervous system.
As the sympathetic nervous system takes over, the body will remain in an elevated state of stress and become chronically heightened. Symptoms that may emerge include elevated heart rates and blood pressure, gastric reflux, chronic inflammation throughout the body, and even high levels of anxiety or agitation.
How Vagus Nerve Compression Leads To Neuropathy
Constant compression of the vagus nerve from CCI can cause severe inflammation and injury to the nerve’s protective layer. If left untreated, parts of the vagus nerve may become irreversibly damaged. This is also known as neuropathy.
As a consequence of the vagus nerve suffering from such severe damage or neuropathy, the key messages which balance the autonomic nervous system will be impaired. This results in autonomic dysfunction, which can cause many serious neurologic and autonomic conditions to develop.
For example, gastroparesis is a neurologic condition that causes the stomach to empty too slowly. This is a direct result of the vagus nerve’s inability to send digestive messages to the stomach. Gastroparesis causes uncomfortable symptoms, such as nausea, vomiting, bloating, or constipation.
Alternatively, Postural Orthostatic Tachycardia Syndrome (POTS) is an autonomic condition that may occur from neuropathy to the vagus nerve. POTS causes your heart rate to inappropriately accelerate after standing up from a seated or lying position. This is caused by an overactive sympathetic nervous system, where incorrect messages are sent to the heart.
Symptoms Of Vagus Nerve Compression Caused By CCI
It is clear the vagus nerve is a large ‘wandering’ nerve and as it travels far throughout the body, it influences many bodily functions relating to the parasympathetic nervous system.
As a result, compression or damage to the vagus nerve from the unstable vertebrae of CCI can block these important messages and cause varying symptoms across the body.
In addition to the painful symptoms described above, some more widespread (systemic) symptoms may occur throughout the body, such as:
Elevated Heart Rate
A chronically elevated heart rate may occur as the vagus nerve gets irritated or compressed from the unstable vertebrae. The compressed nerve prevents the messages from being sent that signal the heart rate to slow down.
Our ability to hear is assisted by sensory feedback signals sent by the vagus nerve. These signals become blocked or incorrect if the vagus nerve is compressed or damaged, leading to tinnitus or ringing in the ears. Tinnitus can be frustrating and impact quality of life. It may even cause hearing loss over time.
The vagus nerve also carries vital sensory information allowing us to see and interpret our vision. A compressed vagus nerve can interrupt this sensory pathway, causing symptoms such as blurred vision or difficulty focusing the eyes.
Chronic fatigue is an autonomic disorder and brings feelings of complete exhaustion. Little things like getting out of a chair or bed might seem like enormous undertakings and be exhausting. This occurs when the parasympathetic nervous system is inhibited by vagus nerve damage or compression.
The body’s high levels of adrenaline are then maintained by the sympathetic nervous system, a heightened state that results in feelings of burnout. Learn more about chronic fatigue and CCI.
Treatments For CCI-Induced Vagus Nerve Compression
Numerous conservative treatments may help relieve the symptoms of CCI and vagus nerve compression. So long as there is no severe degeneration or dislocations, surgery can oftentimes be avoided.
Conservative treatments include conditioning exercises, stabilizing collars, medications, or alternative therapies. Typically, the goal of these therapies is to reduce stiffness and pain in the neck. However, once the underlying cause of CCI is addressed, the more widespread systemic symptoms caused by vagus nerve compression may resolve.
Conservative Medical Treatment
- Physical Therapy
To better support the neck’s vertebrae, physical therapy exercises are designed to tighten up weak or relaxed neck muscles. These exercises can occasionally be very painful and uncomfortable, which reduces their therapeutic value.
- Upper Cervical Chiropractic Treatment
The goal of upper cervical chiropractic care is to re-align the craniovertebral junction, which is where the neck and head meet.
The goal of this therapy is to stabilize the hypermobile vertebrae, which can be useful for symptom management. However, great care is necessary because there is a risk of over-manipulation, which might potentially make the instability worse.
- Braces Or Neck Collars
A neck collar or brace limits the neck’s range of motion while providing external support for the neck. These can help stabilize an initial injury in the short term. However, neck collars and braces could become uncomfortable over time.
Both over-the-counter and prescription drugs can aid in reducing neck discomfort and inflammation. Due to the possibility of negative side effects, it is frequently advised against using the majority of medications for an extended period.
It’s important to discuss pharmacological pain management options with your doctor.
Advanced Medical Interventions
The latest advancements in treating CCI include regenerative therapies, which are minimally-invasive and low-risk treatment options. The doctors at the Centeno-Schultz Clinic use these state-of-the-art options for treating CCI and vagus nerve compression.
Regenerative therapy medicine can alleviate the symptoms of CCI as they promote healing and neck stabilization. Healing the injured tissues of CCI, rather than masking the symptoms, slows the condition’s progression.
Additionally, healing promotes longer-lasting relief from persistent neck pain and the side effects of vagus nerve compression. Studies have shown that regenerative therapies can be more effective than steroids or other pharmaceutical treatment options.
Regenerative therapy options for CCI include Platelet-Rich Plasma therapy (PRP) and Percutaneous Implantation of the Craniocervical Junction ligaments (PICL) procedures. Learn more about these therapies and how they work below.
Platelet-Rich Plasma Therapy (PRP)
PRP therapy involves drawing a blood sample, concentrating the platelets, and injecting this concentrated solution into damaged tissues using image guidance. PRP can be injected into the tissues affected by CCI, including overstretched ligaments, damaged vertebrae and discs, and compressed nerves.
The concentrated solution of PRP is rich in your body’s natural healing and regenerative factors. This therapy treats CCI by promoting recovery of the damaged tissues to relieve debilitating symptoms.
Percutaneous Implantation of the Craniocervical Junction ligaments (PICL)
CCI stands for craniocervical instability which means that the ligaments that hold the head on are too loose. To help that problem, we developed a new procedure called PICL which stands for Percutaneous Implantation of the CCJ Ligaments.
This is still an investigational procedure that has already changed many lives and helped patients avoid a complication-laden upper cervical fusion. To learn more, see my video below:
Don’t Let CCI and Vagus Nerve Compression Cause You More Pain
CCI is caused by a weakening of the ligaments that hold the head to the neck, resulting in instability. This can be painful and debilitating, but it can also result in autonomic dysfunction if the instability causes vagus nerve compression. CCI is treated based on its severity and associated symptoms, with conservative treatments always being prioritized.
Don’t suffer from the discomfort, pain, and other debilitating signs and symptoms that come with vagus nerve compression and craniocervical instability (CCI).
Consult a Centeno-Shultz health expert who specializes in surgical, innovative, and conservative treatment modalities and is well-versed in CCI. This will guarantee the best possible health outcomes and provide relief from the symptoms caused by CCI and vagus nerve compression.