Vertigo – Cervicogenic (neck origin):
Sally is a 54 year-old woman who has been working as a hairdresser for over 20 years. She has a history of chronic neck pain and headaches, for which she takes Ibuprofen (an anti-inflammatory) for pain relief and visits a massage therapist at the local shopping centre every couple of months. However, in the last three months, Sally has noticed transient dizziness to the point she feels nauseous and has to stop all activities completely.
Sally describes her dizziness as a “whoosh” sort of feeling that travels around the entire head, particularly when rotating to the right as she looks at the side mirror while driving and also when she quickly brings
her head up after washing her hair. As symptoms got worse, Sally visited her local GP. The GP ordered blood tests and various scans to rule out any serious pathology. The GP also did a thorough ear examination to ensure there is no ear involvement causing the dizziness. All the pathology tests came back clear, apart from some wax in both ears. Sally was instructed to take Stemetil to give her relief from the dizziness and associated nausea.
A week later, Sally finds that her dizziness is deteriorating and that she cannot move her head as the dizziness starts ‘straight away’. Sally made a trip to our practice thinking that there may be some involvement of her neck as it gets exacerbated with any head movement.
Upon examination, it was found that Sally’s head was tilted slightly to the right and her shoulder height was higher on the left. She had an increased neck curve, rounded shoulders and a very flat upper back. Upon range of motion testing, Sally demonstrated limited movement to right neck rotation, tightness in flexion and a sharp pain as she extended her neck. Careful palpation revealed muscle spasm on left lower cervical spine and limited movement upon springing on the lower cervical facet joints. Endurance testing of the neck muscles revealed very poor ability to hold a sustained position, as was the quality of her neck movement pattern during the neck flexion test.
Eye-tracking of Sally’s visual fields were all unremarkable, as was her deep tendon reflexes, sensory and motor testing of the upper limbs. A x-ray examination of the cervical spine was performed, and this revealed a slight loss of cervical curve and mild loss of C5/6 disc space.
All these findings were discussed with Sally. A diagnosis of cervicogenic vertigo was given and a treatment plan was discussed. Treatment was suggested and this was to involve gentle manipulation of the lower cervical facet joints, soft tissue massage and musculoskeletal dry needling in aim to improve mobility, break up muscle spasm and improve circulation around the neck and head.
It is hoped that Sally will respond quite favourably. Initially we expect that the intensity, duration and frequency of her vertigo to be reduced. However, some remaining neck pain and stiffness could be envisaged which may addressed by her continuing with neck exercises to improve endurance of the spinal muscles. Her workstation both at home and at work will need to reviewed to ensure optimal work ergonomics. In addition, a report will be sent to Sally’s GP to communicate her progress.