What are the management options for cervicogenic dizziness?

Management of Cervicogenic Dizziness

Manual therapy combined with vestibular rehabilitation exercises is the most effective treatment approach for cervicogenic dizziness, with significant improvement typically seen within 4-8 weeks of consistent therapy. 1, 2

Diagnostic Considerations

Before initiating treatment for cervicogenic dizziness, it's essential to rule out other causes of dizziness:

• Differential diagnosis must include:

  • BPPV (use Dix-Hallpike maneuver)
  • Vestibular neuritis/labyrinthitis
  • Ménière's disease
  • Vestibular migraine
  • Cerebrovascular events
  • Anxiety or panic disorder 3, 1

• Diagnostic criteria for cervicogenic dizziness:

  • Dizziness temporally associated with neck pain
  • Dizziness provoked by specific neck positions or movements
  • Presence of cervical pathology (confirmed by imaging if necessary)
  • Exclusion of other vestibular disorders 4

• Recommended imaging:

  • MRI of cervical spine is preferred to evaluate cord compression, nerve root impingement, and soft tissue abnormalities
  • CT may be helpful for assessing bony structures 3, 1

Treatment Algorithm

First-line Treatment:

1. Manual therapy techniques:

   • Gentle spinal manipulation
   • Soft tissue mobilization
   • Joint mobilization of the cervical spine 5, 6, 7

2. Cervical stability exercises:

   • Deep neck flexor strengthening
   • Proprioceptive training
   • Postural correction exercises 5, 4

3. Vestibular rehabilitation:

   • Gaze stabilization exercises
   • Balance training
   • Habituation exercises 2, 5

Second-line Treatment:

1. Physical modalities:

   • Ultrasound therapy
   • Heat/cold therapy
   • TENS (Transcutaneous Electrical Nerve Stimulation) 6, 7

2. Postural education:

   • Ergonomic adjustments
   • Activity modification
   • Workplace adaptations 2, 4

Important Cautions:

• Avoid vestibular suppressant medications such as antihistamines or benzodiazepines as they are not recommended for long-term management and may interfere with central compensation 3
• Avoid self-manipulation of the cervical spine as this can worsen symptoms or cause injury 6
• Consider surgical consultation only if there is significant cord compression or progressive neurological symptoms 1

Monitoring and Follow-up

• Reassess symptoms every 2-4 weeks using validated tools such as the Dizziness Handicap Inventory (DHI)
• Expect significant improvement within 4-8 weeks of consistent therapy 5
• Monitor for neurological progression, as worsening symptoms may indicate need for more aggressive intervention 1

Special Considerations

• For patients with upper cervical instability:

  • Use more gentle manual techniques
  • Focus on deep stabilizer strengthening before progressing to more dynamic exercises 5

• For patients with comorbid conditions:

  • Address associated conditions like POTS (Postural Orthostatic Tachycardia Syndrome) that may exacerbate dizziness 5
  • Consider cardiovascular assessment if appropriate

Treatment Efficacy

Case reports demonstrate significant improvement in cervicogenic dizziness with conservative management:

• DHI scores can improve from moderate handicap (50) to less than mild handicap (10) within 8 months 5
• Complete resolution of symptoms has been documented at 6-month follow-up with appropriate treatment 6

The combination of manual therapy and vestibular rehabilitation appears to be most effective, addressing both the cervical dysfunction and the resulting proprioceptive disturbance that causes dizziness 2, 4.