Vertigo is a common complaint, affecting millions of people worldwide. While there are various causes of vertigo, one often overlooked factor is the dysfunction of the neck. Cervicogenic vertigo, specifically, refers to dizziness or disequilibrium originating from abnormal proprioceptive activity in the upper cervical region. This article will delve into the causes, symptoms, evaluation, and treatment options for cervicogenic vertigo, with a particular focus on the effectiveness of upper cervical chiropractic.

Understanding Cervicogenic Vertigo

Cervicogenic vertigo is believed to be primarily caused by altered mechanoreceptive input in the upper cervical region. The top of the neck, known as the upper cervical region, contains the occiput and C1-3 facet joints, which are densely populated with nerve endings supplying 50% of proprioceptive input in the neck. Proprioception is crucial for determining our body’s position in space and maintaining balance.

When there is joint dysfunction, degeneration, or muscle hyperactivity in the upper cervical spine, it can lead to abnormal stimulation of the joint capsules and mechanical receptors in the muscles. This disruption in the transmission of information from the neck to the brain can result in confusion and dizziness. Whiplash injuries are a common cause of cervicogenic vertigo, with up to 80% of individuals experiencing late-onset dizziness, vertigo, or disequilibrium following such injuries.

Recognizing the Symptoms of Cervicogenic Vertigo

Identifying cervicogenic vertigo can be challenging due to its overlapping symptoms with other vestibular disorders. However, there are some distinct features that can help differentiate it from other causes of vertigo. The most common symptom is a history of dizziness associated with neck movement and pain. The episodes are typically short and provoked by movement, but they can be eased by maintaining a stable position.

In addition to dizziness, cervicogenic vertigo may be accompanied by symptoms such as light-headedness, a floating sensation, unsteadiness, headaches, or general imbalance. However, true “spinning” vertigo, characterized by a sensation of the room spinning, suggests a non-cervicogenic origin, such as Benign Paroxysmal Positional Vertigo (BPPV).

To further assess cervicogenic vertigo, healthcare professionals may look for signs such as a loss of neck range of motion, upper cervical tenderness, and upper cervical segmental joint restriction. Deep pressure on the suboccipital region may reproduce vertigo in some patients. Additionally, tightness in the suboccipital, paracervical, trapezius, SCM, and pectoral muscles is often observed.

Evaluating Cervicogenic Vertigo

Accurately diagnosing cervicogenic vertigo requires a comprehensive evaluation to rule out other potential causes. The most common cause of vertigo is BPPV, accounting for approximately 42% of all cases. Therefore, it is crucial to differentiate between cervicogenic vertigo and BPPV using specialized tests.

The Head-fixed/body-turn test, also known as the Neck torsion test, isolates neck mechanoreceptors without stimulating the vestibular system. By rotating the body on a stool while stabilizing the head, healthcare professionals can assess whether dizziness persists when the head is stable, suggesting cervicogenic vertigo. On the other hand, head rotation exacerbates cervicogenic vertigo symptoms, while those with BPPV are typically more affected by coupled movements.

The Dix-Hallpike test is another useful tool for identifying BPPV and cervicogenic vertigo. This test involves rotating the head 45 degrees and quickly bringing the sitting patient onto their back with their head extended off the table to 30 degrees. The position is held for at least 15 seconds, and any reported vertigo or observed nystagmus can help confirm the diagnosis.

The Role of Upper Cervical Chiropractic in Treating Cervicogenic Vertigo

Upper cervical chiropractic has shown promising results in the management of cervicogenic vertigo. By focusing on restoring normal function to the neck, chiropractic adjustments and massage can assist in relieving vertigo symptoms. However, it’s important to note that cervicogenic vertigo often has multiple causes, which may require additional interventions.

In addition to chiropractic adjustments and massage, myofascial release and stretching of the suboccipital, SCM, upper trapezius, levator, and pectoral muscles may be necessary. Postural correction for upper crossed syndrome and breathing exercises for individuals with dysfunctional respiration can also contribute to the overall treatment plan. Paying particular attention to the deep neck flexor muscles, such as the longus colli and longus capitis, can help alleviate symptoms.

If cervicogenic vertigo coexists with BPPV, vestibular rehabilitation therapy, including canalith repositioning maneuvers and home-based exercises, may be required. Brandt-Daroff exercises, in particular, have been successful in resolving symptoms in 98% of BPPV cases within two weeks. In cases where conservative therapy is ineffective, drugs that sedate the inner ear may be considered, and a referral to a neurologist or ENT specialist might be necessary.

Exercises to Aid in the Recovery from Cervicogenic Vertigo

In addition to chiropractic care, certain exercises can help individuals recover from cervicogenic vertigo. These exercises aim to improve neck strength, flexibility, and proprioception. It is important to note that exercises should be performed under the guidance of a healthcare professional, such as a chiropractor or physical therapist, to ensure proper technique and avoid exacerbating symptoms.

Neck Range of Motion Exercises: Gentle neck rotations, lateral flexion, and flexion-extension exercises can help improve the range of motion and reduce stiffness in the neck.

Strengthening Exercises: Isometric exercises targeting the deep neck flexor muscles, such as the chin tuck exercise, can help strengthen the neck muscles and improve stability.

Balance and Proprioception Exercises: Standing on one leg, performing head movements while maintaining balance, and using balance boards can enhance proprioception and improve overall balance.

Stretching Exercises: Stretching exercises for the suboccipital, SCM, upper trapezius, levator, and pectoral muscles can help alleviate tightness and improve range of motion.


Cervicogenic vertigo can significantly impact an individual’s quality of life, but with the right approach, it can be effectively managed. Upper cervical chiropractic, in combination with other interventions such as massage, exercises, and vestibular rehabilitation therapy, offers a comprehensive treatment plan for relieving vertigo symptoms. By addressing the underlying causes and promoting optimal neck function, individuals can regain their balance and enjoy a life free from the constraints of cervicogenic vertigo.

If you are experiencing cervicogenic vertigo and seeking answers, consider consulting a chiropractor specializing in upper cervical care. They can help determine the cause of your vertigo and provide personalized treatment, including chiropractic adjustments, massage therapy, and exercises to build a resilient neck. Take the first step towards a vertigo-free life by scheduling an appointment today.

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1. Lalwani AK. Vertigo dysequilibrium and imbalance with aging. In: Jackler RK, Brackmann DE, editors. Neurotology. St. Louis: Mosby; 1994. p. 527-34.
2. Albernaz PLM, Cruz NA, Ganaça MM. As doenças vestibulares periféricas e centrais: classificação, diagnóstico e tratamento. Rev Bras Otorinolaring 1968:541-8.
3. Fitz-Ritson D. Neuroanatomy and neurophysiology of the upper cervical spine. In: Vernon H. ed. The Upper Cervical Syndrome: Chiropractic Diagnosis and Treatment. Baltimore: Williams and Wilkens, 1988:48-85.
4. RyanMS, Cope S. Cervical vertigo. Lancet.1955;2:1355- 1358.
5. Furman JM, Cass SP. Balance Disorders: A Case-Study Approach. Philadelphia, Pa: FA Davis; 1996.
6. Hulse M. Disequilibrium caused by a functional disturbance of the upper cervical spine, clinical aspects and differential diagnosis. Manual Medicine 1983; 1(1):18-23.
7. Cooper S, Daniel PM (1963) Muscle spindles in man: their morphology in the lumbricals and the deep muscles of the neck. Brain 86:563–586.
8. Telian AS, Shepard NT. Update on vestibular rehabilitation therapy. Otolaryngol Clin North Am 1996;29:359-71.
9. Wyke B. Neurology of the cervical joints. Physiotherapy 1979; 65(3):72-76.
10. Oostendorp RAB, Van Eupen AAJM, Van Erp J, Elvers H. Dizziness following whiplash injury: a neuro-otological study in manual therapy practice and therapeutic implication. The Journal of Manual and Manipulative Therapy 1999;7(3):123–30.
11.Rubin W. Whiplash with vestibular involvement. Arch Otolaryngol. 1973;97:85-87.
12.BrownJJ. Cervical contributions to balance: cervical vertigo. In: Berthoz A, Vidal PP, Graf W, eds. The Head Neck Sensory Motor System. New York, NY: Oxford University Press; 1992:644-647.
13. Basmajian JV. Basis for autonomic regulation. In: Basmajian J, editor. Biofeedback principle and practice for clinicians. Baltimore:William & Wilkins; 1989. p. 37-48.
14. Ojala M, Palo J. The aetiology of dizziness and how to examine a dizzy patient. Ann Med 1991;23:225-30.
15. Takasaki, H., V. Johnston, et al. (2011). “Driving with a chronic whiplash-associated disorder: a review of patients’ perspectives.” Archives of physical medicine and rehabilitation 92(1): 106-110
16. Norre M, Stevens A. Le nystagmus cervical et les troubles fonctionnels de lacolonne cervicale. Acta Oto-Rhino-Larynologica Belgica 1976; (30)5.
17. Phillipszoon AJ. Neck torsion nystagmus. Pract Oto-Rhi- no-Laryngologist. 1963;25:339-344.
18. Huijbregts P, Vidal P. Dizziness in orthopaedic physical therapy practice: Classification and pathophysiology. J Manual Manipulative Ther 2004;12:199-214.
19. Galm R, Rittmeister M, Schmitt E. Vertigo in patients with cervical spine dysfunction. Eur Spine J 1998;7:55–58.
20. Brunarski D. Autonomic nervous system disturbances of cervical origin including disorders of equilibrium. In: Vernon H,ed.Upper Cervical Syndrome. Baltimore:Williams and Wilkins,1988:
21. Fitz-Ritson D. The chiropractic management and rehabilitation of cervical trauma. JMPT 1990;13(1):17-25.
22. Brandt T, Daroff RB. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol. 1980;106: 484-485.