Alexander Gentile

Cervicogenic Dizziness

Cervicogenic Dizziness:
o Definition: Cervicogenic Dizziness is a term used to describe
symptoms of dizziness that originate from the cervical spine.
o This disorder has also been known as cervical vertigo, proprioceptive
vertigo and cervicogenic vertigo.
o At one point cervicogenic dizziness was thought to be the result of
impinged cervical dorsal nerve roots and vestibular nuclei of the neck
receptors.
Causes:
o Cervicogenic dizziness is often provoked by particular neck postures no
matter what the orientation of the head is to gravity.
o Cervicogenic dizziness is most often coupled with flexion-extension
injuries (ex. whiplash) and not from vestibular dysfunction.
Cervicogenic dizziness may result from whiplash, cervical spine
dysfunction or cervical spine muscle spasms.
o Cervicogenic dizziness has been found in patients with severe cervical
arthritis, herniated cervical discs and head trauma.
Common signs and symptoms of these pathologies include:
ataxia, unsteadiness of gait, postural imbalances associated
with neck pain, limited neck ROM, and cluster headaches.
Differential Diagnosis:
o Differentially diagnosing cervicogenic dizziness can be very difficult as
you have to rule out vestibular disorders or central nervous system
pathologies such as benign paroxysmal positional vertigo,
perilymphatic fistula, labyrinthine concussions, migraine-related
vertigo, and central/peripheral vestibular dysfunctions.
o Taking accurate and thorough patient history of previous cervical
pathologies, noting the time of onset and occurrence of episodes are
also important in diagnosing cervicogenic dizziness.
Physicians orders are not always very descriptive when it comes
to writing referrals so if a patients symptoms describe vertigo
first a central/peripheral vestibular disorder needs to be ruled
out.
The onset of cervicogenic dizziness symptoms can be sudden or
gradual (days to years) and episodic number/duration of events
should last minutes to hours and be elicited by a PT.
Possible symptoms that are treatable by PTs are: transient
dizziness, cervical pain, limited cervical ROM, radicular UE
symptoms, headaches, balance complaints, jaw pain, visual
sensitivity, nausea/vomiting, anxiety and fatigue.
Benign paroxysmal positional vertigo will present as true vertigo,
have an onset of more than 2 weeks after head trauma and last
less than a minute after positional changes.

Perilymphatic fistula has an onset of 24-72 hours after head

trauma and episodes that last minutes to hours.
o The examination procedure should rule out central/peripheral nervous
system dysfunctions and vestibular disorders through special testing
and history gathering.
The first step of the process is to find out if there is neck pain
associated with the dizziness. If there is no neck pain related to
dizziness than cervicogenic dizziness is unlikely. Though if neck
pain is related than CNS dysfunction, vestibular disorders and
vertebrobasilar insufficiency need to be ruled out.
The second step is to then measure the AROM of the neck and
inquire about pain or dizziness existing in any of the
movements. Also an upper quarter screening may be performed
at this time to rule out any PNS vestibular dysfunction.
The next step is to check the stability of the neck by performing
transverse and alar ligament testing to rule out central canal
compression/CNS dysfunction.
After that the next step is to perform a Dix-Hallpike
maneuver/vertebral artery test. If these tests are negative than
BPPV and VBI are ruled out and cervicogenic dizziness is more
likely.
Treatment on the cervical dysfunction can begin at this point
and if symptoms are reduced than cervicogenic dizziness is
likely and if no improvement is shown than a vestibular disorder
is likely. Either way the patient should be referred to a MD or
VR-PT for vestibular testing.
Treatment:
o Cervicogenic dizziness has been shown to be treatable by means of
conservative approaches by combining orthopedic therapy and
vestibular rehabilitation.
o The orthopedic therapy component is centered on decreasing the neck
pain that is causing the cervicogenic dizziness through manual
therapy, therapeutic exercises and cryotherapy.
By decreasing muscle spasms and trigger points in the cervical
muscles the irritation of the cervical proprioceptors can be
reduced and therefore treat the symptoms of cervicogenic
dizziness.
Performing such interventions as STM, mobilization of joints,
trigger point releases, deep cervical muscle releases, ROM
exercises, and ice packs multiple times per day have been
shown to decrease the spasms and trigger points in the
musculature.
Other interventions found to be effective are cervical traction,
strengthening of weak/elongated muscles, and postural reeducation.

The vestibular rehabilitation component is focused on the habituation

of the sensory inputs of cervical proprioceptors and vestibular
receptors related to balance.
Interventions include gaze stabilization exercises (VORx1 and
VORx2) and balancing exercises with graded exposure to many
different inputs to re-educate the patients vestibular system.

Sources

Wrisley DM, Sparto PJ, Whitney SL, Furman JM. Cervicogenic Dizziness: A Review of
Diagnosis and Treatment. J Orthop Sports Phys Ther Journal of Orthopaedic & Sports
Physical Therapy. 2000;30(12):755-766. doi:10.2519/jospt.2000.30.12.755.
Cervicogenic Dizziness. Vestibular Disorders Association.
http://vestibular.org/cervicogenic-dizziness. Published July 2012. Accessed June 23,
2016.
http://www.neuropt.org/docs/vsig-physician-fact-sheets/cervicogenic-dizziness.pdf?
sfvrsn=2