Cervicogenic Vertigo and Chiropractic

Cervicogenic Vertigo: Causes, Symptoms, and Chiropractic Management

I have been fascinated by the human body since I was a child. One of the processes I am still fascinated by is balance. Learning to balance, walk, run, play sports, throw and catch objects are the most complicated things your body learns to do, yet it seems so simple. Learning to balance and walk is achieved by your brain before speaking your first word. What an incredible achievement, your brain learning to coordinate your muscles to keep your centre of mass to be vertically aligned. By which I mean, your brain learns to balance your head on your neck, your torso over your pelvis and your pelvis over your feet vertically and move it around without falling. I hope you agree that it simply incredible! It is something that is easy to take for granted as an adult, it seems so simple, doesn’t it?

Why am I discussion the concept of balance you may well ask. The reason for all this fascination with balance and postural control is do build the excitement and anticipation for this second blog on vertigo. In this blog, we will discuss the concept of cervicogenic vertigo, a less common cause of vertigo that can be difficult to diagnose and even more difficult to manage. If you missed our previous blog on vertigo, it is well worth a read to provide background information on vertigo and the more common causes for it.

Cervicogenic vertigo is a condition where dizziness or a sensation of imbalance stems from issues in the cervical spine (the neck). While it is less recognised compared to other causes of vertigo, such as vestibular disorders (inner ear dysfunction), and benign paroxysmal positional vertigo (BPPV), cervicogenic vertigo can significantly impact an individual’s quality of life. Before we dive into cervicogenic vertigo, it is worth discussing the complex and fascinating process of balance and proprioception.

Postural Control and Balance

Over the course of the last few blogs, we have discussed cervicogenic headaches, dizziness, migraines, and BPPV. These conditions share several characteristics that you will see once if you have read this and the other blogs. Altered proprioceptive input, postural dysfunction and altered muscle function (movement patterns) are all characteristics these conditions share¹. Therefore, a good understanding of the role of postural control, balance and how the brain coordinates these complex tasks is important when addressing these conditions. My goal with these blogs, is to educate the public, students and clinicians with clear and simple language.

It is important for us to appreciate how complex a task upright walking and postural control is. It is something that has been heavily researched in cybernetics and robotic where the complexities of such a task are really appreciated². Postural control and balance is maintained by the integration of multiple sensory inputs, including in the inner ear, eyes, feet, ankles, knees, hips and spine³. The key aspect of this complex, multisystem integration that relates to the topic of cervicogenic vertigo is a complex set of reflexes that coordinate the inner ear (vestibular system), the eye muscles and visual field (ocular system), and spinal muscles. The vestibular system interacts with muscles of the eyes and spinal muscles to create the sensation and maintenance of balance³. These reflexes are called the vestibulo-ocular (inner ear and eye) reflex, the vestibulo-collic (inner ear and neck) reflex and the vestibulo-spinal (inner ear and back) reflex to produce the appropriate responses to postural balance and control³.

The coordination of these reflexes requires a huge amount of sensory input from the eyes, ears, neck and spine to create the sensation and maintenance of balance. Therefore, anything that damages these systems, such as a physical trauma to the spine and neck, can have a devastating affect on your brains ability to maintain your posture and balance.

What Is Cervicogenic Vertigo?

Cervicogenic vertigo occurs when problems in the cervical spine disrupt normal proprioceptive signals — the sensory inputs that help the brain interpret balance and spatial orientation. The condition is closely linked to neck pain, stiffness, or a history of neck trauma¹.

Unlike vertigo caused by inner ear issues, cervicogenic vertigo often accompanies neck movements or sustained postures, such as looking up or down for an extended period. In some people, there could be a combination of these, such as a history of a car crash/whiplash type injury that causes spinal/neck dysfunction and they have an occupation that causes them to have to maintain poor posture for prolonged periods. I have been incredibly frustrated by some therapists I have interacted with over the course of my clinical career that say things like “your next posture is the best posture” to their patients. This reduces this complex problem to a simple “just keep yourself moving” attitude, which might be great advice for most patients. However, failing to consider the patients individual health status, previous medical history and their lifestyle will only lead to the patient failing to feel better. For those patients with complex, neurological conditions, such as vertigo, the need for individualised care is paramount.

Vestibular Migraine

Vestibular migraine is a disorder of the inner ear that can almost be seen as the combination of migraine and vertigo, where the patient experiences migraines with frequent episodes of vertigo^4–6. As the diagram below demonstrates, there is a significant link between the upper neck and neural/brain pathways of the eyes and inner ear that, when injured, can cause the brain to receive incorrect information, leading to headaches, migraines, dizziness and vertigo.

Causes of Cervicogenic Vertigo

The exact mechanisms underlying cervicogenic vertigo are not fully understood, but several factors contribute to its development:

1. Neck Injuries: Whiplash injuries from car accidents or sports trauma can damage the cervical spine’s soft tissues and joints, disrupting neural input.
2. Postural Strain: Prolonged poor posture, especially during desk work or using digital devices, places excessive strain on the cervical spine, potentially causing dizziness.
3. Joint Dysfunction: Irritation or misalignment of the cervical vertebrae, particularly the upper cervical spine (C1-C3), may interfere with signals sent to the brain about head and neck position.
4. Degenerative Conditions: Conditions such as osteoarthritis or degenerative disc disease can affect cervical spine mechanics and lead to vertigo.
5. Muscle Tension: Tightness in the neck and shoulder muscles can affect blood flow and neural communication, contributing to dizziness.

Common Symptoms

Individuals with cervicogenic vertigo may experience:

• A spinning sensation or feeling of imbalance triggered by neck movements.
• Neck pain, stiffness, or tenderness.
• Headaches, often at the base of the skull.
• Visual disturbances or difficulty focusing.
• Nausea, though less common than in inner ear-related vertigo.

Chiropractic Management of Cervicogenic Vertigo

Chiropractors specialise in diagnosing and treating neuromusculoskeletal disorders, making them well-equipped to address cervicogenic vertigo. Here’s how chiropractic care can help:

1. Comprehensive Assessment

A chiropractor begins with a detailed evaluation to determine the root cause of the vertigo. This includes a physical exam, postural analysis, and specific tests to assess cervical spine function. They may also collaborate with other healthcare providers if additional diagnostic imaging or testing is required. Here at Spriggs Chiropractic, we may use x-rays of your spine to assess for spinal alignment and function, especially in cases where previous trauma may be a contributing factor.

2. Spinal Adjustments

Cervical spine adjustments, or manipulations, help restore proper mobility to the vertebrae. This reduces joint dysfunction, alleviates nerve irritation, and improves proprioceptive signalling. We have discussed in detail in a previous blog post “How Chiropractic Works”.

3. Soft Tissue Therapy

Tight muscles and fascia around the neck can contribute to restricted movement and discomfort. Chiropractors use techniques such as trigger point therapy, myofascial release, or massage to relax tense muscles and improve circulation.

4. Postural Correction

Many cases of cervicogenic vertigo stem from poor posture. Chiropractors provide ergonomic advice, stretching routines, and exercises to strengthen neck and upper back muscles, promoting optimal posture when sitting, driving and working. Here at Spriggs Chiropractic, workstation ergonomics will be discussed with assessment if needed to ensure your desk is setup for you. I personally advocate for having an “active workstation” so you can change your position easily with increased variability. An active workstation includes having a sit-stand desk, having a Swiss ball to sit on, a good quality chair and even devices that allow you to challenge your balance, such as a desk treadmill or a Bosu ball to stand on from time to time. Having an active workstation doesn’t mean standing for prolonged periods, it means having the equipment and means to change your posture throughout the day.

5. Vestibular Rehabilitation Exercises

In some cases, chiropractors may incorporate specific exercises to improve balance and reduce vertigo symptoms. These exercises target the proprioceptive and vestibular systems to enhance coordination and stability. I have uploaded some of these targeted cervical spine exercises to our YouTube channel. If you suffer from chronic neck pain and the associated disorders we have discussed over the last few blog posts, you might find these helpful!

6. Lifestyle and Preventive Strategies

Long-term management often involves addressing lifestyle factors. Chiropractors may recommend changes in sleep positions, workstation setup, or activity levels to reduce strain on the cervical spine.

Conclusion

Cervicogenic vertigo, though challenging to diagnose, can be effectively managed with chiropractic care. By addressing the root causes — whether they stem from joint dysfunction, muscle tension, or posture — chiropractors can help alleviate symptoms and improve overall quality of life. If you or someone you know is struggling with unexplained dizziness and neck discomfort, consider consulting a chiropractic clinic to explore non-invasive and holistic treatment options.

For more information about how chiropractic might be able to help you, call us on 01635 43238 or email to hello@spriggschiropractic.co.uk or make an enquiry through the button at the top of the website pages.

References:

1. Gill-Lussier J, Saliba I, Barthélemy D. Proprioceptive Cervicogenic Dizziness Care Trajectories in Patient Subpopulations: A Scoping Review. J Clin Med. 2023;12(5). doi:10.3390/jcm12051884
2. Van Der Kooij H, Jacobs R, Koopman B, Grootenboer H. A multisensory integration model of human stance control. Biol Cybern. 1999;80(5):299-308. doi:10.1007/s004220050527
3. Appiah-Kubi KO, Wright WG. Vestibular training promotes adaptation of multisensory integration in postural control. Gait Posture. 2019;73(June):215-220. doi:10.1016/j.gaitpost.2019.07.197
4. O’Toole R, Watson D. Manual Cervicle Therapy and Vestibular Migraines: A Case Series. Heal Open Res. 2024;5(12):1-29.
5. Lempert T, Olesen J, Furman J, et al. Vestibular migraine: Diagnostic criteria. J Vestib Res Equilib Orientat. 2012;22(4):167-172. doi:10.3233/VES-2012-0453
6. Dieterich M, Obermann M, Celebisoy N. Vestibular migraine: the most frequent entity of episodic vertigo. J Neurol. 2016;263:82-89. doi:10.1007/s00415-015-7905-2