Dizziness stemming from a neck injury or chronic stiffness is known as cervical vertigo or cervicogenic dizziness. Unlike most vertigo, which originates in the inner ear, this condition stems from an issue within the neck’s cervical spine. Receiving an accurate diagnosis and appropriate care often requires seeing multiple types of providers. This guide maps out the necessary specialists involved, from initial consultation to final rehabilitative treatment.
Understanding Cervical Vertigo
Cervical vertigo results from a sensory conflict between the body’s systems that maintain balance and spatial orientation. This occurs when proprioceptive signals from the joints and muscles of the upper neck (C1-C3 segments) are altered or mismatched with input from the visual and vestibular systems. These sensory receptors in the neck send incorrect information about head position to the brainstem’s vestibular nuclei.
This conflicting information leads the brain to register a sensation of movement or unsteadiness, resulting in dizziness. Symptoms are often triggered or worsened by specific neck movements or prolonged postures, differentiating it from other forms of vertigo. Patients typically report floating, unsteadiness, or disequilibrium rather than a true spinning sensation, though true vertigo can also occur.
Unlike many inner ear disorders, cervical vertigo typically does not involve auditory symptoms like hearing loss or tinnitus. Accompanying symptoms include neck pain, stiffness, or reduced range of motion, which relate directly to the underlying musculoskeletal issue. Neck discomfort linked to the onset of dizziness is a primary indicator of a cervicogenic origin.
The Initial Consultation and Referral Process
The medical journey for cervical vertigo often begins with a Primary Care Physician (PCP) or General Practitioner, who serves as the initial point of contact. The PCP conducts a thorough medical history and physical examination to rule out common, non-cervical causes of dizziness. These causes include medication side effects, dehydration, blood pressure fluctuations, or common benign inner ear conditions.
During this initial consultation, the PCP may perform simple maneuvers or tests to assess eye movements and basic balance. This helps differentiate between central nervous system issues and more peripheral causes. They may also manage acute symptoms like neck pain or stiffness with initial treatments, such as anti-inflammatories or muscle relaxants.
Since specialized diagnostic testing is usually required, the PCP acts as the gatekeeper, deciding which specialist is most appropriate for a definitive diagnosis. This initial step prevents patients from delaying care by seeking treatment from a specialist prematurely. The PCP ensures the subsequent specialist consultation is focused and necessary, based on the preliminary findings.
Key Specialists for Diagnosis
Once common causes are excluded, the diagnostic pathway requires two types of doctors to confirm the cervicogenic origin and rule out serious mimickers. The Neurologist determines if the dizziness is related to the central nervous system (CNS). They perform detailed neurological examinations and may order advanced imaging, such as Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scans.
The Neurologist’s goal is to exclude serious conditions like stroke, transient ischemic attacks, or multiple sclerosis, which can present with disequilibrium and vertigo. By ruling out these central pathologies, the Neurologist helps confirm that the issue is peripheral, originating outside the brain and spinal cord.
Concurrently, an Otolaryngologist (ENT), particularly a Neurotologist specializing in balance disorders, differentiates cervical vertigo from inner ear causes. Conditions like Benign Paroxysmal Positional Vertigo (BPPV), Meniere’s disease, or vestibular neuritis often mimic these symptoms. The ENT specialist uses diagnostic tools like Videonystagmography (VNG) or caloric testing to assess vestibular system function.
If vestibular testing results are normal, or if findings do not fully explain the dizziness, it strengthens the hypothesis that the neck is the primary source. The combined effort of the Neurologist (ruling out central causes) and the Neurotologist (ruling out primary inner ear causes) is required for a definitive diagnosis. This process of elimination is necessary because no single, objective test exists to confirm cervical vertigo.
Primary Treatment Providers
Once the diagnosis of cervical vertigo is confirmed, treatment is primarily rehabilitative. The Physical Therapist (PT) specializing in vestibular or orthopedic conditions becomes the primary care provider. Physical therapy is the most effective long-term treatment approach, focusing on normalizing the conflicting sensory input.
A core component of this therapy is cervical proprioceptive training, which improves the neck’s awareness of its position in space. Techniques like head-on-trunk relocation and joint repositioning exercises recalibrate the faulty signals sent from the neck joints to the brain.
Physical therapists also employ manual therapy techniques, such as gentle joint mobilization and soft tissue work, to reduce muscle tension and restore normal range of motion in the cervical spine. Addressing joint stiffness in the upper neck is important because restricted movement can exacerbate the sensory mismatch.
Vestibular rehabilitation exercises, including gaze stabilization and habituation exercises, are frequently incorporated. These help the brain adapt to the altered sensory input and reduce the sensation of dizziness.
Some patients may benefit from the expertise of a Chiropractor or Manual Therapist who focuses on adjusting or mobilizing the cervical spine. This treatment aims to improve mechanical function and alignment, which can indirectly reduce the irritation of the neck’s proprioceptors. Treatment should be gentle and coordinated with the rehabilitative exercises prescribed by the Physical Therapist.
For individuals whose neck pain is severe and complicates rehabilitation, a Pain Management Specialist may be involved. These specialists offer targeted interventions, such as trigger point injections or specific nerve blocks, to temporarily alleviate severe pain. This allows the patient to fully participate in the physical therapy program, ensuring both the mechanical and sensory components of the condition are addressed.