Patients and doctors alike often associate dizziness with either a problem in the inner ear or an issue in the brain. But if there is also neck pain involved, dizziness may have nothing to do with the inner ear or the brain; it may be a symptom of a problem in a very specific part of the cervical spine in the neck. Let’s first review the anatomy of the cervical spine.
Cervical Spine Anatomy
The cervical spine makes up the uppermost portion of the spinal column and serves as the structural foundation of the neck. The cervical spine houses seven vertebrae (spinal bones), each stacked one atop the other, and each vertebra is cushioned and protected by intervetebral discs both above and below each level. The cervical spine also contains joints (called facet joints), two on the back of every vertebra, so 14 in total. Muscles, tendons, ligaments, tendons, and nerves are additional structures located in the cervical spine. They provide cervical support and control neck movements.
When we have symptoms of dizziness with neck pain, in most cases, the culprit is our upper neck. Watch Dr. Centeno’s short video below to learn more:
The Body’s Balancing Systems
The upper neck (top levels of the cervical spine), inner ears, and eyes, while parts of three separate systems, actually work in a very coordinated fashion to keep the body in balance. How does this work? The upper cervical spine contains position-sense information, via the nerves, that works closely with the eyes and inner ears. Having multiple systems that control and maintain balance allows us to retain proper positioning, keeping us upright, moving, walking, and so on. This multisystem balance function works best, however, when all structures are strong and in top-working condition.
When there’s a weak link in the balance chain, communications between the upper neck, inner ears, and eyes can become jumbled, and dizziness can result. In addition to the balance system issues, irritated facet joints in the cervical spine can cause headaches, which is also common with dizziness and neck pain.
Nonsurgical Treatment Solutions for Neck Pain and Dizziness
When dizziness is related to upper-neck pain, addressing the dizziness requires treating whatever is causing the neck pain. The key to finding nonsurgical solutions is to work with your interventional orthopedic physician to determine what is causing the neck pain. Physical therapy can be a good place to start. If it fails to relieve the neck pain and dizziness trigger-point dry-needling techniques (NOT trigger-point injections of substances like steroids or anesthetics as these can be toxic to the muscle) can be used if there are weak or tight knots in the muscle.
Arthritis in or injuries to the facet joints is another issue that could cause dizziness and neck pain, especially if there are also accompanying headaches. Precise image-guided injections of platelet-rich plasma into the damaged facet joints can be a good solution.
Neck pain, dizziness, and headaches can also occur if the ligaments in the upper cervical spine are damaged or have become loose. Damaged ligaments not only create excessive wear and tear on the spinal column but also irritate the surrounding nerves as loose ligaments allow the head to move too much. Prolotherapy or a PRP injection may be able to tighten those loose ligaments. If there is craniocervical junction (CCJ) instability due to ligament issues, a more complex injection procedure may also be an option.
Treatments to Avoid for Neck Pain and Dizziness
Treatments to avoid for neck pain and dizziness include the following:
- Anti-inflammatory steroids have many well-known side effects, can destroy healing stem cells, and become less effective with each subsequent injection.
- Radiofrequency ablation is a nerve destruction procedure that, in this case, burns the nerves at the facet joint that is damaged, creating more problems in the process.
- Cervical fusion is a permanent highly invasive surgery that stops neck movement at the affected fused vertebrae. Side effects are abundant, more damage such as adjacent segment disease is common, and recovery times are long.
Dizziness often results from a problem in the cervical spine. If you also have neck pain, it’s possible your dizziness is coming from your neck. Add in headaches, and it’s highly likely the culprit is your upper neck. It’s best to stay away from treatments that create more problems than they solve, such as steroid injections, RFA, and fusions, and opt instead for nonsurgical regenerative medicine solutions.