Cervicogenic Dizziness

There is much debate over the existence of cervicogenic vertigo, which would be rotational movement associated with neck pain. Cervicogenic dizziness (CGD) however is a feeling of dizziness often described as lightheadedness (not presyncope) or that a patient has a floating head  which is associated neck pain and often with decreased balance. 

Etiology
The mechanism by which cervical pain or dysfunction could lead to dizziness is in dispute, it is thought that inflammation or irritation of the cervical roots or facet joints could cause disruption to the proprioceptive receptors (cervical joint and tendon receptors) in the neck. These receptors are responsible to the postural neck reflexes which are linked with spinal cord, brain stem, cerebrum and cerebellum.   It is thought that upper cervical spine proprioception is responsible for the generation of cervico-ocular reflex  (COR) which works with the vestibular ocular reflex at lower frequencies. Disruption to proprioception is said to result in a mismatch of information to the balance centres due that cause ongoing dizziness and balance impairment.

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Treatment of CGD,
It has been well established that when treating musculoskeletal conditions of the lower limb that we retrain proprioception, think your classic ankle sprain. But how often are we doing this with our neck pain patients? Or even assessing their proprioception.  Treatment of CGD, involves both treating ongoing neck pain with Pain relief, manual therapy and strengthening exercises as well as including treatment to retain oculomotor function, cervical sensorimotor retraining and balance.  

Diagnosis of CGD is one made through extensive assessment with the exclusion or absence of otological or neurological clinical findings. Often patients present with a mixed picture of cause of dizziness from central or peripheral vestibular conditions and CGD. Studies that looked at Whiplash associated disorder found that patients often present with otologic impairments when tested Oostervald 1991, found 79% of patients had cervical nystagmus and over 40% had positional nystagmus that can be attributed to BPPV both central or peripheral causes. Other studies have shown changes abnormal changes on posturography and calorics post whiplash. Concussion is another cause for CGD and often patients will also present with a mixed picture of dizziness. It is therefore important that patients are receiving a thorough assessment that reviews all systems so that we can ensure all patients are receiving the most complete intervention.