Cervical vertigo, often called cervicogenic dizziness, is a condition where dizziness or unsteadiness originates from a problem in the neck structures. This occurs due to a mismatch between the neck’s sensory receptors and the inner ear’s balance system, sending confusing signals to the brain about head position. Because its symptoms overlap with many other balance disorders, cervical vertigo is considered a diagnosis of exclusion. Clinicians must systematically rule out common causes of dizziness, such as inner ear problems or neurological conditions, before attributing symptoms to the cervical spine. The diagnostic process combines a detailed patient history, specific physical maneuvers, and advanced testing.
Initial Clinical Assessment
The diagnostic journey begins with a thorough patient interview to capture a precise symptom profile. Patients typically report unsteadiness, disequilibrium, or lightheadedness, rather than the true spinning sensation associated with traditional vertigo. A defining feature is that the dizziness is consistently triggered by specific neck movements or sustained awkward head positions.
The clinician inquires about the duration and timing of symptoms; episodes usually last minutes to hours and are often accompanied by neck pain, stiffness, or limited range of motion. Neck discomfort is generally regarded as a requirement for this diagnosis. A general neurological examination is then performed to screen for signs suggesting a central nervous system issue, such as problems with gait, coordination, or reflexes. This screening helps differentiate a peripheral neck-related issue from a central problem within the brain or brainstem.
Physical Maneuvers to Isolate Neck Involvement
Once the initial history suggests neck involvement, the assessment moves to targeted physical maneuvers designed to provoke dizziness. Testing the cervical range of motion, often restricted in these patients, is a simple first step to identify pain or stiffness. Reproduction of dizziness during these movements is a strong indicator of a cervical source.
A more specific assessment is the Neck Torsion Test, which isolates the cervical spine’s proprioceptive input from the inner ear’s vestibular input. The patient sits on a swivel chair with their head held still while the body is rotated underneath them. If dizziness is reproduced when the body is turned while the head remains stable, the source is likely in the neck, as the inner ear has not been stimulated.
Another specialized test is the Smooth Pursuit Neck Torsion (SPNT) Test, which evaluates the stability of eye movements while the neck is held in a twisted position. The patient’s head is kept steady while they track a slowly moving visual target with their eyes, first in a neutral position and then while their torso is rotated up to 45 degrees. A positive result occurs if the ability to smoothly track the target is reduced, or if dizziness is provoked during the neck-torqued position compared to the neutral position. The SPNT test is a valuable tool for confirming the neck’s role, particularly in patients with whiplash-associated dizziness.
Ruling Out Inner Ear and Neurological Causes
Because cervical vertigo is a diagnosis of exclusion, extensive testing is required to confirm the dizziness is not originating from the inner ear or the brain. Peripheral vestibular disorders are the most common causes of dizziness and must be systematically ruled out. The Dix-Hallpike test is routinely performed to check for Benign Paroxysmal Positional Vertigo (BPPV), the most frequent cause of vertigo often misdiagnosed as a cervical issue.
Comprehensive vestibular function tests, such as Videonystagmography (VNG), assess the health of the inner ear and the central nervous system’s control of eye movements. VNG uses infrared video goggles to record involuntary eye movements (nystagmus) during various positional and caloric tests. The caloric portion stimulates the inner ear with warm and cool air or water, identifying a weakness in one or both ears that points to a peripheral vestibular disorder.
Audiometry, or hearing tests, are also performed to rule out conditions like Meniere’s disease, which presents with vertigo, hearing loss, and ringing in the ears. If VNG and other vestibular tests are negative, it suggests the inner ear is functioning correctly, shifting suspicion back to the neck. If a central cause, such as a stroke or tumor, is suspected due to additional neurological signs, an MRI of the brain may be ordered.
Diagnostic Imaging and Confirmatory Measures
Structural imaging identifies underlying neck pathology that could be contributing to abnormal sensory input. Standard X-rays of the cervical spine can reveal structural issues like degenerative changes, instability, or arthritis, which may affect the joint receptors responsible for proprioception. Advanced imaging, such as a CT scan or an MRI of the cervical spine, provides detailed views of bony structures, intervertebral discs, and soft tissues. While these images may identify a structural problem, they do not definitively prove that the issue is the cause of the dizziness.
The most definitive step often involves a therapeutic trial using a diagnostic nerve block. Injecting a local anesthetic into specific areas of the upper cervical spine, such as the medial branch nerves supplying the facet joints, serves a diagnostic purpose. If the patient’s dizziness is temporarily relieved immediately after the injection, it provides strong evidence that the cervical spine is the source of the symptoms. This positive response acts as confirmatory evidence when all other causes of dizziness have been excluded.