Management of Cervicogenic Dizziness and Neck Muscle Tension
Cervicogenic dizziness should be managed primarily with manual therapy and vestibular rehabilitation exercises, while avoiding routine use of vestibular suppressant medications. 1, 2
Understanding the Condition
Cervicogenic dizziness arises from proprioceptive abnormalities in the cervical spine, typically triggered by head rotation relative to the body while upright (not by changes in head position relative to gravity). 1 The cervical spine contains highly developed proprioceptive receptors that integrate with visual and vestibular systems—when this proprioceptive input becomes disrupted due to neck pathology or muscle dysfunction, dizziness occurs. 3
The condition is characterized by:
- Dizziness accompanied by neck pain 4, 2
- Symptoms triggered by neck movement or sustained neck positions 1
- Restricted cervical range of motion and muscle hypertonicity 5
Diagnostic Approach
The diagnosis is clinical and based on correlating episodes of neck pain with dizziness while excluding other vestibular disorders. 2 There are no definitive imaging findings that diagnose cervicogenic dizziness, and imaging shows high rates of abnormalities even in asymptomatic patients. 6
Key diagnostic considerations:
- Exclude other causes first: Rule out benign paroxysmal positional vertigo (BPPV), vertebrobasilar insufficiency, and primary vestibular disorders 1
- Cervical torsion test appears to be the best diagnostic method for cervicogenic dizziness 3
- Imaging is generally not indicated unless red flags are present (vascular dissection concerns, neurologic deficits, trauma) 6
- If vascular dissection is suspected with unilateral headache and neck pain, CTA or MRA may be warranted 6
Treatment Algorithm
First-Line Treatment
Manual therapy combined with vestibular rehabilitation is the most effective approach. 1, 2, 3
Specific interventions include:
- Spinal manipulation and mobilization targeting cervical dysfunction 5, 2
- Soft tissue release for muscle hypertonicity 5
- Vestibular rehabilitation exercises as adjunctive therapy 1
- Rehabilitative exercises for cervical sensorimotor control 5, 7
What NOT to Do
Vestibular suppressant medications (antihistamines, benzodiazepines) should NOT be routinely used. 1 These medications are ineffective for cervicogenic dizziness because the underlying mechanism is proprioceptive dysfunction, not vestibular pathology.
Treatment Timeline and Expectations
Improvement typically occurs within 4 weeks of appropriate treatment, with many patients remaining asymptomatic at 6-month follow-up when treated with manual therapy and rehabilitation. 5
Special Populations and Modifications
Patients with the following conditions require modified treatment approaches: 1
- Cervical stenosis
- Severe rheumatoid arthritis
- Cervical radiculopathies
- Ankylosing spondylitis
- Other significant spinal pathology
Elderly patients with cervical arthritis have increased risk for persistent postural abnormalities and falls, requiring more cautious progression of treatment. 1
Critical Pitfalls to Avoid
Do not deny appropriate neck pain management while pursuing the diagnosis—treating the cervical dysfunction is both diagnostic and therapeutic 4
Do not perform or recommend self-manipulation of the cervical spine, as this can precipitate or worsen cervicogenic dizziness 5
Do not order routine imaging for suspected cervicogenic dizziness without red flags, as it has no diagnostic value and shows abnormalities in asymptomatic patients 6
Do not assume the neck is the cause simply because neck pain and dizziness coexist—many patients have mixed forms of dizziness requiring assessment of the cervical spine's specific role (nil, minor, major, or compensatory) 7