Can upper neck tension cause vertigo, particularly in individuals with a history of neck injuries or musculoskeletal issues?

Can Upper Neck Tension Cause Vertigo?

Yes, upper neck tension can cause vertigo through a mechanism called cervicogenic dizziness (CGD), which results from impaired cervical proprioception leading to sensory mismatch with vestibular and visual input. 1

Mechanism of Cervicogenic Vertigo

The pathophysiology involves abnormal proprioceptive signals from the cervical spine that conflict with vestibular and visual information:

• Proprioceptive disruption occurs when diseased cervical intervertebral discs develop ingrowth of Ruffini corpuscles, which transmit abnormal sensory signals to the central nervous system 2
• Muscle spindle dysfunction in tense neck muscles secondary to neck pain contributes additional aberrant proprioceptive input 2
• Sensory mismatch between cervical proprioceptive signals and vestibular/visual information creates the subjective sensation of vertigo and unsteadiness 2
• The cervical spine plays a critical role alongside visual and vestibular input for sensorimotor control, and impairment in any component can produce dizziness 1

Clinical Presentation

Cervicogenic dizziness has distinct characteristics that differentiate it from other vertigo causes:

• Non-rotatory dizziness is the typical presentation, described as unsteadiness or imbalance rather than spinning sensation 3
• Intermittent symptoms triggered by neck movements or strenuous activities 3
• Associated neck pain with restricted cervical range of motion in flexion, extension, rotation, and lateral inclination 4
• Neck-related headaches occur more frequently (65.5%) in patients with cervicogenic vertigo compared to those with neck pain alone 4
• Daily or occasional symptoms rather than episodic attacks lasting specific durations 3

Diagnostic Considerations

Determining the cervical spine's role in vertigo requires systematic evaluation:

• Rule out peripheral vestibular causes first: The absence of true rotatory vertigo, hearing loss, tinnitus, or characteristic nystagmus on Dix-Hallpike testing makes BPPV, Menière's disease, and vestibular neuritis unlikely 5, 6
• Assess for central causes: Red flags including severe postural instability with falling, new-onset severe headache, additional neurological symptoms, or downbeating nystagmus without torsional component demand immediate neuroimaging 5
• Evaluate cervical musculoskeletal impairments: Document restricted neck mobility, muscle tension, and pain patterns 4
• Perform balance testing: Static and dynamic posturographic assessments reveal abnormalities in mediolateral and anterior-posterior deviations in patients with cervicogenic vertigo 4

Objective Evidence of Balance Impairment

Research demonstrates measurable balance dysfunction in cervicogenic vertigo:

• 72% of patients with chronic neck pain experience occasional or daily symptoms of unsteadiness and/or dizziness 3
• Abnormal statokinetic parameters are documented on posturography under both "eyes open" and "eyes shut" conditions in patients with neck pain and vertigo compared to controls 4
• Balance abnormalities persist long-term, remaining present 10-13 years after cervical spine surgery 3

Treatment Approach

Manual therapy combined with vestibular rehabilitation exercises is the most effective treatment for cervicogenic dizziness. 6

Specific interventions include:

• Vestibular electrical stimulation: Superficial paravertebral electrical stimulation of neck muscles reduces antigravity failure and increases proprioceptive cervical sensory substitution 7
• Cervical musculoskeletal treatment: Address restricted neck mobility and muscle tension 4
• Sensorimotor control exercises: Target impaired cervical proprioception 1

Critical Pitfalls to Avoid

• Do not assume all neck pain with dizziness is cervicogenic: Many patients present with mixed forms of dizziness, and the neck may have no role (comorbid condition), minor role, major role, or compensatory role 1
• Do not miss central causes: Vertebrobasilar insufficiency can present with neck-related symptoms and requires urgent evaluation if red flags are present 5
• Do not overlook vestibular migraine: This accounts for 14% of adult vertigo cases and can occur without headache, often coexisting with neck pain 6
• Do not order routine neuroimaging without red flags: The diagnostic yield in nonspecific dizziness without vertigo, ataxia, or neurologic deficits is extremely low (<1% for CT, 4% for MRI) 6