What is Cervical Dizziness? The first suppositions on a possible link between neck-head position and sense of balance date back to about two centuries ago, but it is only around 1950 that a real hypothesis of relationship between
- Trauma, neck pain
- Dizziness and / or loss of balance.
It is theorized for the first time the existence of a syndrome characterized by balance and heeling disorders in patients with various types of problems and traumas at the height of the cervical vertebrae (i.e., the neck); the name chosen by the author lily to describe the syndrome can be translated with the expression “cervical vertigo”.
In the following years it was sometimes preferred to speak of “cervical slipping”, as the typical symptom is not a real vertigo (which is perceived by the patient with the sensation of the movement of the body with respect to the environment or the environment with respect to the body), the more a sense of instability.
The exact causes are not yet known, nor do we have any real certainty that there is a direct connection between neck and dizziness (although many doctors have observed the frequent concomitance of the two symptoms), so much so that a rather varied terminology is found in the literature.
- Proprioceptive vertigo,
- Cervicogenic vertigo,
- Cervical heel.
To date there is therefore no complete unanimity in the vision of this syndrome and, even more difficult, it turns out to try to formulate estimates on the spread of this problem (according to some studies it would even account for 9 out of 10 cases of dizziness), also due to the difficulty in diagnosis: there are no clinical or laboratory tests, thus forcing the medical staff to make a diagnosis of exclusion.
Causes of Cervical dizziness
Two main mechanisms are recognized that could underlie cervical vertigo:
- Vascular compression,
- Altered proprioceptive inputs from the upper cervical spine.
Vascular compression
In the first case the cervical vertebrae can in some conditions come to compress the arteries of the neck, thus reducing the normal flow of blood, for example due to:
- Arthrosis,
- Surgical operations,
- Neck manipulations,
- Trauma (car accidents, sports injuries, …).
This reduced blood supply quickly translates into a lack of oxygen, glucose and other molecules necessary for the proper performance of the functions residing in the skull (brain, hearing, sight, …) That the body manifests through a sense of heeling and other symptoms.
Alteration of proprioceptive signals
It is believed that some patients may develop alterations in the management of the sense of balance, which is normally the result of a complex series of different signals that the brain ultimately translates into a muscular response that allows the individual not to fall and to be aware in every instant of one’s position in space.
In fact, the body uses information from various sources:
- Vision, by the eyes
- Position taken at that time
- Mobility (interpreted from movements and vibrations).
In the event that conflicting signals arrive from the neck, or no more information arrives, the brain reacts unpredictably to the lack of coherence between the signals, thus manifesting dizziness and dizziness.
Other
Finally, some authors hypothesize a possible genesis starting from vasomotor changes due to irritation of the cervical sympathetic chain.
Beyond these rather specialized discussions, it is a fact that the evidence to support these hypotheses is at least scarce to date, but it has been established, for example, that cervical lurch often occurs following a whiplash or a head trauma found in association with brain or inner ear injury. Equally often, however, it is difficult to distinguish cervical heel from other underlying medical problems and it is therefore essential to proceed with a careful and reasoned exclusion of other possible causes, before making the diagnosis of cervical vertigo.
Symptoms of neck pain or Cervical dizziness
Individuals with cervical heel generally complain of the sensation of moving with respect to the environment or vice versa, a perception that worsens during head movements or after keeping the head fixed in one position for a long period. These symptoms usually occur accompanied by a feeling of pain in the neck and may be associated with headaches.
Often, the sense of heeling decreases as neck pain is reduce. Symptoms typically last for minutes or hours.
Individuals with cervical vertigo may also report a general difficulty with balance, which can worsen with head or environment movements. Although no formal studies are conducted, true cervical displacement is thought to be rare.
Symptoms accompanying Cervical dizziness vary from person to person, some of the most common being:
- Slip,
- vertigo,
- Balance disorders,
- Skidding associated with headaches,
- Feeling of floating,
- Limitations of motility of the cervical area,
- Difficulty sleeping due to pain,
- Pain referred to the shoulders or shoulder area,
- ataxia (lack of coordination of voluntary muscle movements),
- Unstable walking,
- Postural balance disorder with neck pain,
- Neck pain,
- Tinnitus,
- Hearing loss
- Nausea,
- Feeling of lightheadedness,
- Feeling of numbness.
In light of this great variability, it should now be clear how difficult it is to say that the underlying cause of the disorder is only one, for this reason we tend to speak of a syndrome (a complex of symptoms, which can be caused by the most diverse causes) and not of a specific pathology.
Diagnosis of Cervical dizziness
For the reasons seen in the paragraph dedicated to the causes, to date the diagnosis of cervical displacement is controversial, also because there are no confirmatory diagnostic tests. It is a diagnosis that is typically made in people with trauma or neck pain and symptoms of heeling in which other causes of vertigo have been excluded.
There are no definitions or reference diagnostic tests for identifying cervical vertigo, just as there is no standardized therapeutic approach, and for this reason the diagnostic process is often a source of great frustration for the patient.
In the case of dizziness but absence of neck pain, the diagnosis of cervical vertigo must be excluded
A large number of conditions can give symptoms similar to cervical vertigo, so the combination of neck pain and vertigo should not be the only feature used to describe this disorder.
Cervical vertigo can be defined as the presence of dizziness, balance disturbances or drifts in relation to movements or positions of the cervical spine or concomitant with a stiff or painful neck, but in fact the diagnosis of cervical vertigo is often considered a diagnosis by exclusion.
The path that is sometimes necessary to formulate the diagnosis is multidisciplinary and involves various specialist figures (not necessarily in this order):
- Otolaryngologist for the evaluation of pathologies of the ear, seat of balance,
- Neurologist, to rule out potential central causes of vertigo,
- Cardiologist, to rule out causes related to the blood supply to the brain,
- Orthopedic, to evaluate possible cervical problems.
Many patients, for example, believe they are affected, when in reality it is benign positional vertigo.
Treatment and therapy for neck pain
Cervical vertigo is a difficult disorder to diagnose as well as to treat, unless the exact underlying cause can be pinpointed; the first approach is usually conservative, acting on the neck with
- Drugs (anti- inflammatory, muscle relaxants, cortisone),
- Mild containment by collar or similar (to be used only if prescribed),
- Exercise, stretching and instructions for maintaining correct posture and use of the neck.
In other patients it may be necessary to resort to vestibular rehabilitation, through:
- Eye exercises, balance, walking,
- Gradual exposure to environments that cause dizzying symptoms.
The specialist then evaluates specific forms of physiotherapy manipulation on a case-by-case basis.
In the case of traumatic injuries resulting in whiplash, muscle relaxants and soft cervical collars can be considered, which should however be limited to the acute phase only and should not be worn more than 1-2 hour a day, or in any case always according to specialist indications.
Conclusion
Cervical Dizziness or Cervical vertigo is a sense of heeling caused by problems of the spinal column, at the level of the cervical area; to date not all doctors recognize the existence of this syndrome and, especially in Italy, we are mistakenly customize to generically and erroneously attributing to the cervical many ailments and symptoms that actually have more complex or at least different causes.
However, the fact remains that many patients find themselves having to deal with more or less accentuated and debilitating difficulties caused by the presence of Cervical dizziness; unfortunately, it is sometimes necessary to consult different specialists, from different medical branches, in order to obtain an accurate diagnosis and above all the prescription of a therapy capable of relieving dizziness and any other symptoms present.
