The brain relies on sensory input from the eyes, the inner ears, and from specialized nerve endings in and around joints to provide information concerning movement and spatial orientation. Disruption in any of these systems can impair balance and position sense. While vertigo is most often attributed to a disorder of the vestibular apparatus of the inner ear -- the area that helps us achieve balance -- some cases of vertigo result from problems in the cervical spine. Causes for cervical vertigo include trauma, arthritis and chronic neck pain.
Identifying Cervical Vertigo
Chiropractor Don Fitz-Ritson developed a simple screening test to help differentiate cervical vertigo from vestibular vertigo. The first part of the test is to turn the head from side to side several times in succession. If the vertigo is increased by these movements, it could be related to motion affecting either the inner ear or the cervical spine. For the second part of the test, the subject is seated on a swivel chair; her head is held motionless by the examiner as she swivels back and forth in the chair, causing motion in the neck but not the inner ear. If this part of the test also increases the vertigo, the likely source is the cervical spine.
Research published in 1991 in "Archives of Physical Medicine and Rehabilitation" measured the ability of subjects to accurately reproduce postures of the head and neck. Individuals with chronic neck pain had difficulty with this task. Subsequent research published in the "Journal of Manipulative and Physiological Therapeutics" demonstrated that such subjects, many of whom reported "dizziness," were able to improve the accuracy of their head and neck positioning following specific treatments to address underlying cervical spine problems. Both of these studies implicate impaired motion of the neck as giving rise to disturbances of sensory nerves in the muscles and joints of the cervical spine. These nerves then feed faulty information to the brain, resulting in diminished position sense or dizziness.
About 25 to 50 percent of people who sustain whiplash injuries report vertigo or dizziness as an associated symptom. Deficits in head and neck positioning accuracy have been reported in whiplash patients in 1997 in the journal "Spine." While these symptoms may be caused by the same mechanisms at work in individuals with chronic non-traumatic neck pain, a small study reported in 2006 in the "European Spine Journal" suggests that, for some, the dizziness may result from changes in blood flow patterns through the vertebral arteries feeding into the brainstem.
Both degenerative arthritis and vertigo are common among older adults. A specific cause and effect relationship was sought by researchers who presented their findings in the journal "Clinical Rheumatology" in 2011. They discovered that degenerative arthritis of the neck was more prevalent among those with vertigo. They also noted an increase likelihood of vertigo if the degenerative changes were more severe. Most important, they showed a clear link between the presence of vertigo and impaired circulation through the vertebral arteries due to the arthritic changes in the region.
- Journal of Manipulative and Physiological Therapeutics: Assessment of Cervicogenic Vertigo; Don Fitz-Ritson
- Archives of Physical Medicine and Rehabilitation: Cervicocephalic Kinesthetic Sensibility in Patients with Cervical Pain; M. Revel, C. Andre-Deshays and M. Minguet
- Journal of Manipulative and Physiological Therapeutics: The Effects of Spinal Manipulation on Cervical Kinesthesia in Patients with Chronic Neck Pain: A Pilot Study; R. Rogers
- Spine: Ability to Reproduce Head Position After Whiplash Injury; J. Loudon, M. Ruhl and Edelle Field
- European Spine Journal: Cervical Vertigo and Dizziness After Whiplash Injury; E. Kenji, I. Katsuji, K. Mashashi, et. al.
- Clinical Rheumatology: Vertigo is Associated With Advanced Degenerative Changes in Patients With Cervical Spondylosis; S. Machaly, M. Senna and A. Sadek