From the Guidelines
Dizziness is primarily associated with the vestibular system rather than specific cervical spine nerves, but the upper cervical nerves (C1-C3) can contribute to dizziness through cervicogenic mechanisms, as noted in the clinical practice guideline for benign paroxysmal positional vertigo 1. The cervical proprioceptors in the upper neck muscles and joints provide important information about head position and movement that integrates with vestibular and visual inputs in the brain stem and cerebellum. When these proprioceptive signals are altered due to injury, inflammation, or dysfunction of the upper cervical spine, the brain receives conflicting sensory information, potentially resulting in cervicogenic dizziness. Some key points to consider in the diagnosis and management of dizziness include:
- Differentiating BPPV from other causes of imbalance, dizziness, and vertigo, as recommended in the guideline 1
- Assessing patients with BPPV for factors that modify management, including impaired mobility or balance, central nervous system disorders, a lack of home support, and/or increased risk for falling, as noted in the guideline 1
- Using the Dix-Hallpike maneuver to diagnose posterior semicircular canal BPPV, as recommended in the guideline 1
- Considering the role of patient preferences in making decisions, as discussed in the guideline update group 1 Additionally, the C2 nerve root (particularly through the greater occipital nerve) can refer pain to the head and may be associated with cervicogenic headaches that sometimes present with accompanying dizziness. Treatment typically focuses on addressing the underlying cervical dysfunction through physical therapy, manual therapy, and exercises to improve proprioception and cervical stability, as well as educating patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up, as recommended in the guideline 1.
From the Research
Cervical Spine and Dizziness
The cervical spine plays a significant role in dizziness, particularly in proprioceptive cervicogenic dizziness (CGD) 2. The cervical spine, along with visual and vestibular input, is important for sensorimotor control. Impaired cervical proprioception can lead to symptoms such as:
- Dizziness
- Unsteadiness
- Visual disturbances
- Altered sensorimotor control
Diagnosis and Treatment
Diagnosing CGD can be challenging, as many people present with both neck pain and dizziness, and the onset of both often follows head and neck trauma 2. Treatment directed toward cervical musculoskeletal and sensorimotor control is efficacious in improving symptoms in individuals with cervical musculoskeletal disorders 3, 2. A combination of manual therapy and vestibular rehabilitation can be used to treat cervicogenic dizziness 3.
Mechanisms of Dizziness
The neck can be implicated in dizziness via several mechanisms, including:
- Proprioceptive cervicogenic dizziness (CGD)
- Impaired cervical proprioception
- Cervical musculoskeletal disorders
- Sensorimotor control impairments
Importance of Cervical Spine in Dizziness
Determining the precise role of the cervical spine in dizziness requires a skilled interview and examination for cervical musculoskeletal and related sensorimotor impairments, as well as relevant testing of other potential causes 2. Considering the role of the neck in dizziness allows for a balanced approach in assessment and management, enabling timely and effective intervention for individuals presenting with neck pain and dizziness 2.