Cervicogenic Vertigo

by Anonymous

I had a whiplash injury a few years ago and was diagnosed with cervicogenic vertigo. I have been in treatment and doing exercises ever since. I think that my neck has improved (although I still do have some pain and problems) but the vertigo is still there. If this type of vertigo is neck related, shouldn't it improve with improvement to the neck? Can I still expect the vertigo to go away, or will it be permanent?

Answer:

Hi,
You do not mention what medications you have been on, so I will assume somewhere along the line you were on an anti-spasmotic for your neck.

Cervicogenic vertigo results when injury and spasming in the neck causes a feedback to the brainstem. If you look at the picture, the C2 and C3 nerves from the cervical spine will feedback to the brainstem and irritate it. They send these signals when the neck is in pain. As a result, the brainstem becomes hyper-irritated and causes vertigo.

One of the best medications for this is amitriptyline, low dose taken at night. It is also an anti-spasmotic and it works on those centers of the brainstem responsible for vertigo.

Another option is verapamil, but I have seen better results with the amitriptyline. Hopefully you will have to be on it for only a few months.

If you haven't seen a neurologist yet, I would consider doing that as an MRI of the brain and cervical spine could be considered since you are still having problems.

Good luck!
Mary Kay Betz MS RPA-C



COMMENTS:


I have cervicogenic vertigo also, caused by neck injuries and at least 3 herniated discs in my neck. This is helpful. I have never been on amitryptaline, I have been on valium which is a temporary help to vertigo and anxiety it causes.

I am currently on vicodin for the pain and soma for the muscle knots , spasms and muscle pain. I have no medicine for the vertigo currently. Everything I do aggravates the neck and subsequently exacerbates vertigo. I have tried meclizine but it does not help - in fact it makes my vertigo worse.

what can I do?
I have not had mri of head ,I have had mri of neck and xrays - I also have DDD

Answer:

Hi Rega,

An MRI of the head would get a better look at the brainstem and the brain itself. At this point if your symptoms are clear cut then I am not quite sure if it would change your care.

It might be worthwhile to ask your doctor about the amitriptyline. As you can see by the response to others, this is a dose related treatment. It is a nice anti-spasmotic in addition to treating vertigo..but you must be patient.

Valium is also a good choice. All medications should be combined with a good physical therapy program, a tens unit for the neck and regular massage.

Good luck!
Mary Kay

Over 30 years ago, I had a bodysurfing accident, which resulted in a fractured spine. I had compression fractures of C3, 4 & 5. I was in hospital for several weeks, and in home traction for months. Luckily, I was fit and healthy, and recovered with no apparent residual affects. However, in the past two years I have had several episodes if dizziness and vertigo. It happened after doing Yoga and also Gytonic exercise. My concern is whether I should continue these activities. I am not on any pain, and have no other issues.

Answer

Check with your neurologist. Manipulation of the upper spine could be causing the problem.

Mary Kay


This is a follow-up to a previous question. I have cervicogenic vertigo. I have tried Verapamil and it made me feel even more dizzy. I have also tried amytriptyline and it didn't work, but perhaps I was not on the correct dose. What is the standard dose? If the medications do not work, are there other options to try? I have been doing vestibular exercises for a while now and they have only helped a bit.

Answer:

Generally the vertigo starts to settle down with doses between 40 and 60 mg but I have had some patients who required higher doses. It is important to take time to titrate the dose up slowly over a few months. With chronic vertigo, it may take several months for things to settle down.

Start by taking it two hours before bed as the main side effect is sedation. I generally start patients at 10mg and work upwards.

Good luck.
Mary Kay

Cervicogenic vertigo/headache

This is a follow-up to a previous question. I have cervicogenic vertigo. I have tried Verapamil and it made me feel even more dizzy. I have also tried amytriptyline and it didn't work, but perhaps I was not on the correct dose. What is the standard dose? If the medications do not work, are there other options to try? I have been doing vestibular exercises for a while now and they have only helped a bit.

Answer:
Please see the comments section to your original question for the answer.

Cervicogenic Vertigo

by Anonymous

Hello!

Since 15 months I am suffering from dizziness(light headedness with some memory problems too), base of skull aches and neck stiffness. I have had MRI and MRA of spine , cervical region, and head. They all have come negative except for "mild spondolytic changes" in the cervical region.

I have had severe migraine with nausea and vomiting for 9 years before that. But since these 15 months, the migraines have reduced in severity and frequency. Could the recent symptoms above be another form of my chronic migraine?

Thanks,

A sufferer

Answer:

I suspect with a lot of neck stiffness you are having some mild vertigo associated with spasms. When the neck is in pain and spasming, the pain feeds back to that part of the brainstem that controls balance.

Without any other information such as age, sex, medications tried, it is difficult to make any other assessments.

If you have seen a neurologist who did the MRI and MRA, I would suggest you ask them as you might need further testing.

Good luck..
Mary Kay Betz MS RPA-C

Cevicogenic headache

by Sheila
(United Kingdom)

I am a 65 year old female who has had head pain for at least 5 years. I cannot call it a headache because it is ranges from a very severe acute pain only ever in my left temple and sometimes behind the left eye to a constant dull pain again in this area. I have had MRI scans, CT scans a lumber puncture.

One neuorologist said it was paraoxsysmal hemicrania and tried me on a range of medication ranging from Amitryptiline to the present Gabapentin, and a lot in-between, the names of which i cannot remember. The Gabapentin has brought limited relief.

I have also tried a whole range of alternative therapies and then i went to see a chiropractor. I have had Dystonia (torticollis) for over thirty years and was in a lot of pain with the muscles of my neck as they had gone into spasm. I have regular botox injections in my neck which do help but not with the pain. My chiropractor treated my neck and also my back, there is a problem with some of the discs, and although there wasn't an immediate improvement, over time the neck pain has gone and now i just go for maintenance. Though the headaches are a little better they are still troublesome. Then he just dropped into the conversation that he wouldn't be surprised if i didn't have cervicogenic headaches. i had never heard of them so i started to research and am wondering if he is right.

Sheila

Answer:

Hi Sheila,

Given what you have described in your history you may indeed have cervicogenic headache. This is when the pain in the head is coming from the neck.

You mentioned MRI's, but if you haven't had one of the neck in a while that would be worthwhile considering.

I am glad that someone is doing Botox for the torticollis as that can be excruciating pain. Spasming in the neck sends a "message" through the upper cervical spine directly to the brain and can cause migraines. Through a different mechanism, the spasms pull on the muscles of the scalp and create what is called cervicogenic headaches. They really are a form of tension type headache. I wonder if you are having migraine since the pain is behind the eye. Paroxsysmal hemicrania has pain that is stabbing and shooting pains lasting 10 seconds or so. Migraines are more dull aching pain and last 4-72 hours.

Treatment for the neck physical therapy, chiropractic care, anti-spasmotic medications and a TENS unit. If you do not have a TENS unit, ask your doctor about getting one. By all means continue with Botox if it is helping. Talk to the doctor again about the possiblity that some of it is migraine.

Good luck!
Mary Kay Betz MS RPA-C