Neck Pain And Dizziness: The Inner Ear Is Only Part Of The Picture

Published on Sep 23, 2019

Did you know that your neck can make you dizzy? Most patients don’t know that dizziness also known as cervical vertigo and neck pain can be connected, and many physicians miss this diagnosis.^[1] Why? Both patients and doctors think inner ear or brain when dizziness occurs. However, when the neck component of our balance system which consists of the inner ear, the eyes and the upper neck joints fails, this can cause neck pain and dizziness.

The Cervical Spine and Its Link to Neck Pain and Dizziness

Medical illustration of cervical vertebrae and the skull

VectorMine/Shutterstock

The uppermost part of the spinal column, called the cervical spine, consists of 7 vertebrae with cushioning discs in between each level and 2 joints at the back of each vertebra (14 total, called facet joints). Together with muscles, ligaments, tendons, and nerves, these structures in the cervical spine support and precisely control movement in our neck. When we experience neck pain and dizziness, more often than not it’s from the upper neck (dashed box).

There are actually three different systems that work closely together to keep us balanced. These are the upper neck, the eyes, and the inner ears. Via the nerves that come from the upper neck facet joints and muscles, the upper neck provides position-sense information that coordinates with our eyes and inner ear. The purpose is to assure that we have multiple systems that can keep us upright, walking, and level-headed, and, indeed, all of the input communications must properly sync and agree for you to maintain normal balance and for you to remain in control of your positioning, both physically and mentally. In other words, when these three systems don’t jive, even if it’s just one weak link with information coming in that doesn’t agree with the other two, dizziness can occur.

In addition, the facet joints in this area of the cervical spine can refer pain to the head, which is why headaches can also be a common accompanying feature of neck pain and dizziness.

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Causes of Neck Pain, and Treatment Solutions

Addressing the source of the upper-neck pain is the key to relieving the pain and eliminating dizziness. The goal is to avoid surgery, such as a cervical fusion that permanently disables neck movement and comes with many side effects and lengthy recovery times. There are many injuries and conditions that can cause neck pain and dizziness, and effective nonsurgical treatments will depend on the issue, therefore determining how long this condition will last is not easy. The simplest solution might simply be physical therapy; however, if this doesn’t relieve neck pain and dizziness, there are more treatment solutions that follow.

Trigger Points

Trigger-point dry-needling can be effective because oftentimes the bad input on balance is coming from muscle trigger points here.^[2] This involves inserting small acupuncture needles into tight or weak knots of muscle, which are caused by irritated nerves that supply the neck muscles. Trigger-point injections that involve injecting substances like local anesthetics and steroids can be myotoxic, or toxic to the muscle, and should be avoided.

Cervical Muscle Atrophy

Cervical muscle atrophy or loss of muscle mass is a result of lack of physical activity.^[3],^[4],^[5] When there is an injury to the neck, a decrease in physical activity is the first line of defense to decrease pain resulting in muscle weakness. When the deep cervical muscles, also sometimes known as the multifidus becomes weak, the trapezius, levator scapula and scalenes are muscles that act like the second line of defense to help support the neck. Since these muscles were not designed to offer stability, these become over loaded bringing one shoulder higher throwing off the body alignment. The occipital nerve found in the upper trapezius can get irritated resulting in headaches, as the brachial plexus which is a group of nerves also found in the upper cervical area can lead to numbness in the little finger in the hand, not so much dizziness.

Facet Joints

The facet joints in the upper neck can also become injured or arthritic.^[6] If you have a chronic headache along with neck pain and dizziness, a damaged facet joint could be the culprit, and these can usually be treated by injecting the upper-neck facet joints with platelet rich plasma (PRP).

Upper Neck Ligaments

The ligaments in the upper neck can become stretched or damaged due to an injury or disease, and this can cause both the head and upper neck to have too much movement. This puts pressure on the nerves and can cause neck pain and dizziness, and headaches. T ightening down these ligaments with a prolotherapy or PRP injection may help. If the damaged ligaments are causing a more severe craniocervical junction (CCJ) instability, this requires a more complex injection procedure.

A Word on Steroid Injections and Radiofrequency Ablation Procedures for Neck Pain

Anti-inflammatory steroids and radiofrequency ablation procedures are both common ways to treat neck pain due to facet joint and other injuries. Steroid injections are riddled with side effects, are toxic to stem cells, and can be less and less effective at eliminating pain with each treatment. A radiofrequency ablation (RFA) procedure uses a heated probe to burn away the nerves around the damaged facet joint. The thought is that by destroying the nerve this will stop the pain because the pain can no longer be transmitted to the brain. There is research to support RFA for chronic neck pain due to a damaged facet joint, but burning nerves creates some problems, including creating more damage in the joint since you can’t feel the pain (a Charcot joint), more-frequent and long-term treatments to address returning pain, and more severe pain when it does return.

The upshot? Neck pain and dizziness are commonly caused by upper-neck problems. So if you have neck problems, and also experience dizziness and headaches, make sure that an expert in nonsurgical neck treatment takes a close look!

Originally published: 11/7/2017

Category: Neck/Cervical, Regenexx -PL

References

Reiley AS, Vickory FM, Funderburg SE, Cesario RA, Clendaniel RA. How to diagnose cervicogenic dizziness. Arch Physiother. 2017;7:12. Published 2017 Sep 12. doi:10.1186/s40945-017-0040-x https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759906/ ↑
Gattie ER, Cleland JA, Snodgrass SJ. Dry Needling for Patients With Neck Pain: Protocol of a Randomized Clinical Trial. JMIR Res Protoc. 2017;6(11):e227. Published 2017 Nov 22. doi:10.2196/resprot.7980 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5719229/ ↑
Elliott JM, Pedler AR, Jull GA, Van Wyk L, Galloway GG, OʼLeary SP. Differential changes in muscles composition exist in traumatic and nontraumatic neck pain. Spine (Phila Pa 1976). 2014 Jan 1;39(1):39-47. doi: 10.1097/BRS.0000000000000033.PMID:24270932 https://www.ncbi.nlm.nih.gov/pubmed/24270932 ↑
Elliott JM, Dewald JP, Hornby TG, Walton DM, Parrish TB. Mechanisms underlying chronic whiplash: contributions from an incomplete spinal cord injury?. Pain Med. 2014;15(11):1938–1944. doi:10.1111/pme.12518 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597006/ ↑
Uthaikhup S, Assapun J, Kothan S, Watcharasaksilp K, Elliott JM. Structural changes of the cervical muscles in elder women with cervicogenic headache. Musculoskelet Sci Pract. 2017 Jun;29:1-6. doi: 10.1016/j.msksp.2017.02.002. Epub 2017 Feb 22. PMID: 28259769 https://www.ncbi.nlm.nih.gov/pubmed/28259769 ↑
Mehnert MJ¹, Freedman MK. Update on the role of z-joint injection and radiofrequency neurotomy for cervicogenic headache. PM R. 2013 Mar;5(3):221-7.doi: 10.1016/j.pmrj.2013.01.001. PMID:23481329 https://www.ncbi.nlm.nih.gov/pubmed/23481329 ↑