What is the initial treatment for cervicogenic dizziness?

Initial Treatment for Cervicogenic Dizziness

Exercise therapy, including scapular resistance exercises, postural correction exercises, and general physical activity, should be the initial treatment for cervicogenic dizziness, along with manual therapy of the cervical spine. 1

Diagnosis Considerations

Before initiating treatment, it's important to confirm the diagnosis of cervicogenic dizziness by:

• Excluding other vestibular disorders through history, examination, and vestibular function tests 2
• Identifying correlating episodes of neck pain and dizziness 3
• Assessing for restricted cervical range of motion and muscle hypertonicity 4

First-Line Treatment Approach

1. Manual Therapy

   • Spinal mobilization and manipulation of the cervical spine 5
   • Soft tissue release techniques targeting cervical muscles 4
   • Should be performed by qualified practitioners to avoid complications

2. Exercise Therapy

   • Scapular resistance exercises
   • Postural correction exercises
   • General physical activity for overall conditioning 1
   • Rehabilitative exercises targeting cervical proprioception

3. Education and Activity Modification

   • Patient education about the condition
   • Reassurance about prognosis
   • Modification of activities to avoid symptom triggers 1

4. Pain Management

   • NSAIDs at lowest effective dose for shortest duration
   • Monitor for gastrointestinal, cardiovascular, and renal side effects
   • Avoid opioids unless absolutely necessary 1

Vestibular Rehabilitation

Vestibular rehabilitation may be beneficial as an adjunct treatment, particularly when:

• Symptoms persist after initial manual therapy
• Patient shows signs of vestibular dysfunction
• There's evidence of impaired balance 6

The American Physical Therapy Association recommends vestibular rehabilitation for functional balance impairment, with evidence supporting its use in conjunction with manual therapy 6.

Treatment Duration and Follow-up

• Initial treatment course typically lasts 4-6 weeks 1
• Follow-up evaluation should occur within 1 month after initial treatment to document resolution or persistence of symptoms 6
• If symptoms persist, consider additional diagnostic evaluation for unresolved issues or underlying disorders 6

Special Considerations

• Patients with post-traumatic cervicogenic dizziness may require more intensive and repeated physical treatments 6
• Assess for comorbidities that may modify management, including impaired mobility, balance issues, CNS disorders, and fall risk 6
• For refractory cases after 4-6 weeks of conservative management, consider referral for interventional procedures such as medial branch blocks or cervical epidural injections 1

Treatment Efficacy

Recent evidence shows that a structured manual therapy protocol can significantly reduce dizziness intensity and self-perceived disability both immediately (within 2 days) and at 4-week follow-up 7, supporting the recommendation for manual therapy as a first-line treatment.