Vertigo, dizziness, headache?
First, let's clarify the difference between vertigo and dizziness. The simplest way to differentiate them is by using the basic medical definition.
Vertigo - is the sensation of spinning, tilting, or distortion of otherwise normal movement. You might feel that you are tilting or spinning, which is internal vertigo or that the world around you is titling and spinning, which is referred to as external vertigo.
Dizziness - is a sensation of light-headedness that can make you feel as though you are going to pass out.
It's important to note that since Headaches are very common companion of dizziness originated (caused) by problems in the neck region, the name Cervicogenic Headache (CGH) has become the main way of referencing this particular experience.
Please understand that dizziness and headache often accompany each other (especially today when your psychological state is easily out balance) and merge into a total sensation that may constantly change. You don't have to fixate on a particular wording of this sensation, or medical definitions which are basically the noble attempt to categorize every experience in order to help the next one in line. Remember, each one of us will have our own subjective experience that doesn't have to fit into particular category.
What is important, however, is to be empowered by the knowledge and evidence that exists and worked for others, and apply it to your own unique situation without giving away the power to heal yourself to any external source of information.
With that being said, let's see what is known about cervicogenic dizziness (headache, vertigo), its symptoms and causes, and the possible overlapping issues.
Do you recognize these symptoms?
Those who experience cervicogenic vertigo describe the experience in various ways, and it can be accompanied by other symptoms such as nausea, headache, ringing in the ears (tinnitus), and, more rarely, neck pain.
Patients use phrases such as:
- “When I turn my neck, it often feels like I am suddenly spinning.”
- “It is a sensation of falling in slow motion.”
- “The world around me starts to spin, and I immediately feel nauseated.”
- “I felt off-balance, as everything seemed to tilt around me.”
- “It comes on suddenly with certain neck movements, and I feel like everything was spinning around me. The spinning causes nausea that is often accompanied by an intense headache.”
If you can relate to any of the above statements, or have similar symptoms, then you may be experiencing cervicogenic vertigo.
What causes cervicogenic vertigo?
Research is ongoing into the full range of causes of cervicogenic vertigo, but medical scientists have discovered that the muscles and joints of the neck have a direct connection to the vestibular apparatus.
The vestibular apparatus is the part of the middle ear that is responsible for the sense of orientation and balance. Muscle spasms and joint degeneration can play a role in causing cervicogenic vertigo.
Doctors do know that atherosclerosis (artery blockage in the neck) disrupts blood flow to the inner ear and parts of the brain, causing vertigo, along with other symptoms such as dizziness and a severe headache.
Atherosclerosis is not the only cause of the blocking of blood flow to the brain or inner ear. Previous surgeries, trauma to the neck, and severe arthritis can also block blood flow, causing the same symptoms.
The neck does a lot of work during your lifetime. It is the most mobile part of the spine, and over time, sees significant wear and tear, which can result in cervical spondylosis.
Spondylosis causes the vertebrae and discs to degenerate over time, leading to significant osteoarthritis of the neck. If spondylosis progresses far enough, it can put pressure on the spinal nerves or even the spinal cord. When this happens, symptoms can include:
- Neck pain and stiffness
- Vertigo that happens when moving the neck.
- Pain across the shoulder area, or pain that radiates into the arms
- A grinding or popping sensation that occurs when turning the neck.
Disorders related to Cervicogenic Vertigo
The disorders discussed in this section all have a close link to the cervicogenic region and can occur in conjunction with cervicogenic vertigo.
You may even have a bit of a chicken vs. egg conundrum, as vertigo may appear as a symptom after you experience one or more of the following problems.
As you read through this section, you may have a bit of an “ah-ha” moment when you realize that there is a definitive connection between issues you may have viewed as separate problems until now.
Migraines can be caused by cervicogenic dysfunction and can occur with vertigo.
Migraine sufferers have individual experiences when it comes to how a migraine feels and how long symptoms last.
Some people have migraines with an aura, and the aura may occur before there is any head pain. Auras are difficult to describe as they vary significantly from person to person. A few common ways you will hear auras described include:
- “I see a halo around lights accompanied by ringing in my ears. When those symptoms emerge, I know a migraine is about to start.”
- “I start to feel dizzy, like the world is spinning and usually nauseated.”
- “My neck feels stiff and sore, and I there are wavy lines across my vision.”
- “My vision becomes blurry, and I see blotches of color across my visual field.”
Migraines with aura occur in about 25-30% of migraines. Even if you have an aura, it might not happen with every migraine. Auras are often confused with the much more common prodrome.
A prodrome is the first stage of a migraine attack and is experienced by approximately 80% of migraine sufferers. Prodromes often give patients a sense that something is not right. They may notice a change in their personalities, crave certain foods or beverages, fatigue, or changes in bowel and bladder habits.
There is one advantage to having a recognizable prodrome or aura with your migraine. Triptans, which are a medication used to abort migraines, work far better when they are taken in the prodrome stage of a migraine.
Unfortunately, many sufferers cannot identify their migraine in its earliest stages, making triptans less effective once the pain has set in.
Tension headaches, which are caused by muscle contractions in the neck, face, or scalp, often have a cervicogenic cause.
Most people suffer from tension headaches at some point in their life, but problems in the cervicogenic region may lead to tension headaches happening more frequently or becoming chronic.
Tension headaches also put patients at risk of developing rebound headaches, as regularly taking over-the-counter medication to treat the pain associated with the headache can lead to a rebound headache from taking too much medicine.
Tension headaches are easy to identify. Most patients describe a sensation of a tightening band around the head (similar to the sensation of wearing a hat that is too small). Others describe tension headaches as dull, achy pain, or the feeling of having a clamp placed around their skull.
The pain typically starts in the neck and spreads to the back of the head. Unlike migraines, you do not have sympathetic nervous system problems such as nausea, vomiting, light sensitivity, or auras with tension headaches.
Though there are numerous causes of tension headaches, researchers have determined that a significant number of tension headaches are linked to muscle spasms in the cervicogenic area.
Treating problems in the neck region often results in a substantial reduction in tension headaches.
See our post exploring tension headaches in depth ->
Vestibular Migraine (or, Migraine-Associated Vertigo)
Vestibular migraines occur when people experience migraines where vertigo is a prominent feature.
Vertigo associated with this type of migraine can last anywhere from five minutes to seventy-two hours, causing significant discomfort and an inability to function until the migraine resolves.
Those who experience vestibular migraines often describe vertigo occurring in the prodrome period of the headache before the pain appears.
For some sufferers, the migraine may only consist of vertigo without the typical pain of a migraine. Typical migraine pain can appear, but the most common signs of a vestibular migraine include:
- Nausea and vomiting
- Problems with balance leading to trouble walking, and often, frequent falls
- Motion sensitivity causing dizziness when you move your head, body, or even eyes
- Feeling confuse or disoriented
- Extreme sensitivity to sound—common sounds can feel like they are reverberating across your brain.
Vestibular migraines usually arise in people who have a pre-existing diagnosis of migraine headaches.
The migraine might be associated with pain in the neck that radiates into the back and shoulders, producing a tightness and tension that is difficult to relieve.
Pain in the arms that radiates into the fingers is also associated with neck arthropathy or compressed nerves in the cervical spine.
Movement of the head can cause the vestibular migraine to worsen significantly, causing most sufferers to want to lay down in a quiet place until the spell passes.
See our post exploring vestibular migraine ->
Ringing in the ears (tinnitus) is also related to cervicogenic vertigo, but the causes of tinnitus are not well understood by medical science.
- Tinnitus causes include age-related hearing loss, exposure to loud noises, changes to the ear bones, muscle spasms in the inner ear, and head or neck injuries.
- Blood vessel disorders, such as atherosclerosis, high blood pressure, and the malformation of capillaries, are also linked to tinnitus, but the mechanism that causes the link is poorly understood.
Tinnitus can range from mild to severe, and those who suffer from it describe it in various ways.
It can sound like a constant ringing in the ears, or a pulsating roar sounding like the ocean. Tinnitus can occur in only one ear, but more commonly affects both ears.
You can also have pulsatile tinnitus, which is a sound that pulses in time with your heartbeat.
See our post exploring Tinnitus in detail ->
Nausea and vomiting:
- Nausea, and less frequently, vomiting, can occur in conjunction with cervicogenic vertigo. Nausea is also a prominent feature inmost types of migraine headaches, so there is an interconnectedness between these symptoms.
- Vertigo disrupts the autonomic nervous system, which can result in nausea and vomiting. Think of nausea you can experience on a carnival ride. Vertigo works much the same way in disorienting your senses and causing your body to react with nausea.
Altered Posturgraphy (Inability to maintain balance)
A lack of balance, according to a pub med search of various scientific studies, done in 2018, is the single most defining symptom of cervicogenic vertigo.
Given the overwhelming number of causes for lack of balance, the symptom lacks specificity, and other causes have to rule out before a definitive diagnosis can be made.
Difficulty maintaining balance can lead to a more sedentary lifestyle, which has its own set of complications.
Falls related to altered posturography pose a danger of further injury to the cervicogenic region, meaning a fall can then make the initial problem worse.
The overlap in symptoms
As you can see from the causes of cervicogenic vertigo, and the related disorders, there is a significant overlap in the cause and symptoms of many medical issues related to the cervicogenic region.
The overlap in symptoms, and the relation between these disorders, can often make the process of diagnosis complicated.
Unfortunately, many who suffer from these disorders often encounter misdiagnosis that leads to inappropriate treatment. It is normal to feel fearful and frustrated when you know something is wrong, but your doctor can’t seem to find the answers you need.
If you feel that vertigo, balance issues, and the headaches you experience are related, you are probably right.
Getting a doctor to understand the relationship might be a challenging undertaking. Many doctors tend to look at one symptom at a time and diagnose the most common cause without taking the time to explore the possibility of a cluster of related symptoms.
Find a doctor who is willing to explore the possibility that your symptoms arise from one common cause.
Patients often have to take some responsibility for their own diagnosis and healing, and should not hesitate to do so. After all, you are the one who has to live with the discomfort of cervicogenic vertigo and any associated disorders.
Give yourself permission to work with, not against, your doctor to find the answers you need to get back to feeling your best.
Diagnosing cervicogenic vertigo
It can be challenging to diagnose cervicogenic vertigo, as many other disorders can closely mimic the symptoms.
Your doctor will likely want to rule out:
- Central vertigo can be caused by serious issues such as strokes, multiple sclerosis, or tumors.
- Diseases of the inner ear
- Benign paroxysmal positional vertigo (BPPV), which is the most common type of vertigo, and is caused by a disturbance in the inner ear. The symptoms associated with BPPV closely match those of cervicogenic vertigo, and it is often difficult to tell the two apart. Pain in the neck or vertigo that started after an injury to the neck is crucial to distinguishing cervicogenic vertigo from BPPV. However, many people who have issues related to the cervical spine don’t exhibit neck pain and may not have sustained a specific injury to the neck.
Once your doctor has ruled out other causes, she should perform a specific physical exam searching for nystagmus.
Nystagmus is a sporadic eye movement brought on by the movement of the head and is often related to cervicogenic vertigo.
Additional testing your doctor may order can include:
- AnMRI of the neck, and sometimes the brain
- AnMRA which is when a dye is injected into the arteries before the scan
- Flexion extension x-rays of the cervical spine, performed by having you bend your neck forward and then backward, as far as you can comfortably
- A Doppler ultrasound of the vertebral arteries
Consider Healing, not Just Treatment
The diagnosis of cervicogenic vertigo is one of exclusion, meaning your symptoms meet the criteria, and no other cause can be found. It can be a time-consuming process, especially if you have co-existing disorders such as migraines and tinnitus.
Cervicogenic problems that overlap and run together can cause a great deal of frustration for those with symptoms that doctors attempt to treat one at a time instead of recognizing that they arise from the same cause.
These problems can lead to a significant loss of quality of life, as well as pose a danger of injury.
The loss of balance associated with cervicogenic vertigo poses an increased risk of falls, which can lead to further injuries.
Though seeking a diagnosis can be frustrating, there is another way.
Our body is one gloriously designed vehicle where each part has an intricate working relationship with the other parts.
When one part of the body, or mind, is not working correctly, it can cause a cascading effect, leading to a growing number of medical problems.
Making corrections that last means addressing the entire system rather than attempting to squash individual symptoms.
Symptoms, though often uncomfortable, painful, and even debilitating, are how our body sends the signal that one part needs attention; or rather, one part, at the end of the chain of many parts, is signaling about the crisis of the whole.
Yes, the part of system can give us a "hint". However, it's never about a single element being out of balance (except a direct physical impact, or injury); it's about the system as a whole sustaining a more fundamental imbalance.
In treating the symptom without addressing the underlying problem, you will end up playing a frustrating game of medical whack-a-mole. Instead, see your symptoms as a whole and solve the problems starting from fundamentals of human well-being.
Once you understand the relationship between the problems that can arise from the cervicogenic region, which is the purpose of this page, you can then focus on treating the root cause, or rather, root imbalance.
It isn't always about fixing a broken part of our body; it's more about addressing the systemic issues influencing the whole.
What does it mean?
It means addressing fundamentals of life.
It means that in order to find healing you may need to reconsider a "conventional" approach of fixing a part, and honestly re-evaluate your own role in bringing a problem into your life in the first place.
Now, the latter may cause uncomfortable feelings, or even appear as insulting; but very often, that's the cost of healing: facing and standing in front of the inconvenience of truth.
I do understand the confusion and frustration of not knowing exactly what is happening. But since you may have a multitude of pathways leading to a "noise" on the surface, it's wise to stop separating those pathways from one another and focus on that which influences the whole "network" of pathways.
So, if you truly want to heal, you might want to let go this desire to "know" the exact cause, and instead, become motivated to address distorted fundamentals of life (which in most cases is the main imbalance at the root of the problem).
Why nothing seems to work?
Because probably you, like myself, experience symptoms on the intersection of several conditions such as ON, CGH, Migraine, Tension headaches, and more.
Since we are dealing with the mix symptoms (research is not yet clear on how it all manifests), targeting one symptom in isolation is a painful (and costly) waste of time.
We need to address underlying processes on a more global scale that sometimes means getting results which are not immediate but sustainable (assuming you are not fainting right at this moment because of unbearable pain; call emergency now if that's the case).
The idea is: Let's deal with the pain and distress so we can have energy, motivation, and mental clarity for a more radical treatment.
‘The time to fix the roof is when the sun is shining.’
We're going to prepare ourselves (help the sun to come out) in order for the true healing process to even begin (fixing the roof).
Physical pain and emotional frustration (resulting from not understanding what's happening and how to deal with it) is what turns our lives into a miserable existence. Generally, we experience a lack of will to do anything until this continuous confusion goes away.
You can learn here why your emotional and mental states can literally generate physical pain.
We need to clear the fog, so to speak, in order to breath freely for a moment so we can gather energy and realize that there's a way out of all this.