From the Research
Cervicogenic vertigo is a type of dizziness that originates from disorders or dysfunction in the cervical spine (neck) and should be treated with a multidisciplinary approach focusing on addressing the underlying neck issues, with physical therapy as the cornerstone of treatment.
Treatment Approach
The treatment approach for cervicogenic vertigo typically involves a combination of physical therapy, medications, and lifestyle modifications.
- Physical therapy should include manual therapy techniques, cervical spine mobilization, and specific exercises to improve neck proprioception and stability, with patients undergoing a course of 6-8 weeks of physical therapy with sessions 2-3 times weekly 1.
- Medications may include vestibular suppressants like meclizine (25mg every 4-6 hours as needed) for acute symptoms, but should be limited to short-term use as they can delay central compensation 2.
- NSAIDs such as ibuprofen (400-600mg three times daily with food) can help manage associated neck pain and inflammation 2.
- For persistent cases, a cervical collar may provide temporary relief by limiting neck movement, but prolonged use should be avoided as it can lead to muscle weakness 3.
Diagnostic Approach
Diagnosing cervicogenic vertigo can be challenging, and a systematic diagnostic approach is necessary to rule out other vestibular, medical, and vascular disorders that cause dizziness 4.
- The diagnosis of cervicogenic dizziness is dependent upon correlating symptoms of imbalance and dizziness with neck pain and excluding other vestibular disorders based on history, examination, and vestibular function tests 5.
- A stepwise process for evaluating patients who may have cervicogenic dizziness should be followed, including steps to exclude diagnoses that can present with symptoms similar to those seen in cervicogenic dizziness 4.
Pathogenesis
Cervicogenic vertigo occurs because the upper cervical spine shares neural connections with vestibular nuclei and visual pathways; dysfunction in neck proprioceptors can create a sensory mismatch, resulting in dizziness 2.
- There are different hypotheses explaining the vertigo of a cervical origin, including proprioceptive cervical vertigo, Barré-Lieou syndrome, rotational vertebral artery vertigo, and migraine-associated cervicogenic vertigo 2.
- Most patients see improvement with conservative management, though symptoms may recur if underlying neck issues persist 1.