|  | Cancer | Cervical Cancer

Cervicogenic Dizziness: Neck-Related Vertigo Causes, Diagnosis & Treatment

Cervicogenic dizziness (CGD) is a diagnosis of exclusion: dizziness/unsteadiness attributed to cervical spine dysfunction after ruling out vestibular, neurological, vascular, and cardiac causes. It affects 20–58% of whiplash patients and is prevalent in chronic neck pain populations.

Pathophysiology

Abnormal cervical afferent input (from facet joints, muscles, ligaments, discs) conflicts with vestibular and visual inputs → sensory mismatch → dizziness. Key structures: C1–C3 facets, suboccipital muscles, cervical muscle spindles (high density).

Common Causes

  • Whiplash-associated disorders (WAD)
  • Cervical spondylosis / facet arthropathy
  • Cervical disc herniation (upper cervical)
  • Post-concussion / post-traumatic
  • Cervical muscle spasm / myofascial dysfunction
  • Post-surgical (fusion, arthroplasty)
  • Forward head posture / cervicothoracic junction dysfunction

Clinical Features

  • Dizziness (not true vertigo) — lightheadedness, unsteadiness, "foggy" head
  • Neck pain/stiffness (often but not always)
  • Provoked by neck movement/position (extension, rotation, sustained postures)
  • Associated: headache (cervicogenic), shoulder/arm pain, visual disturbances, nausea
  • Duration: minutes to hours; chronic if untreated

Diagnostic Criteria (Consensus)

  1. Neck pain/dysfunction + dizziness
  2. Temporal correlation: neck symptoms precede/accompany dizziness
  3. Exclusion of: BPPV (Dix-Hallpike), vestibular neuritis, vestibular migraine, Ménière's, vertebrobasilar insufficiency, central lesions (MRI), cardiac, medication effects.
  4. Positive cervical provocation tests (e.g., neck torsion nystagmus, smooth pursuit neck torsion test).

Treatment (Multimodal)

  • Physical therapy (cornerstone): Manual therapy (mobilization, SNAGs), cervical sensorimotor training (joint position error, gaze stability), deep neck flexor strengthening, posture re-education, cervicothoracic mobilization.
  • Vestibular rehabilitation: If vestibular hypofunction coexists.
  • Pharmacologic: NSAIDs, muscle relaxants (short-term), neuropathic agents if radiculopathy; no specific CGD drug.
  • Injection therapies: Facet blocks, medial branch blocks, trigger point injections — diagnostic + therapeutic.
  • Psychological: CBT for fear-avoidance, catastrophizing.
  • Surgery: Rare; only for structural pathology (cord compression, instability) unresponsive to conservative care.

Prognosis

Most improve with 6–12 weeks targeted PT. Chronicity predicted by: delayed treatment, high disability, psychosocial factors, comorbid vestibular migraine. Early intervention yields best outcomes.

CGD is treatable. Accurate diagnosis requires systematic exclusion of mimics and skilled cervical assessment. Refer to PT with vestibular/cervical expertise.

Cervical Cancer - Related Articles