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

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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

upper neck

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.

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. Tightening 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/CervicalRegenexx-PL

References

  1. 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/
  2. 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/
  3. 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
  4. 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/
  5. 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
  6. 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

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30 thoughts on “Neck Pain And Dizziness: The Inner Ear Is Only Part Of The Picture

  1. Bryon Winkelman

    Have you had patients with base of skull pain and upper cervical pain…who also has evidence indicating an inner ear condition, notably Superior Semicircular Canal Dehiscence?? I have evidence of evidence of upper cervical instability and this condition. I suspect one is affecting the other or vice versa.

    1. Regenexx Team Post author

      Bryon,
      No, but unless SSCD has been confirmed by a CT scan, then I would treat the neck first.

  2. George Justice

    I am a very successful Regenexx medial right knee stem cell patient. Your article regarding the neck causes me to wonder if the tinnitus I have is caused by neck issues. When I turn from left to right and rotate my neck the tinnitus gets louder and softer. The sound is 100% of the time.

    I have limited range of motion in my neck.

    1. Regenexx Team Post author

      George,
      Great to hear your knee is doing so well! Tinnitus can be caused by, and or aggravated by neck issues. It can also be caused by many different things, even hip replacement related cobalt poisoning. The change in volume upon turning your head and the limited range of motion in your neck suggest there’s a good chance we can help.

  3. Steph

    I have osteoarthritis in my neck. I get pain like pressure in my head. Dizziness and feel nausish by the end of the day. Makes me panic sometimes.
    Is this normal?

    1. Regenexx Team Post author

      Steph,

      These are common symptoms for upper cervical issues, but symptoms that should be looked into, and non surgical solutions sought. If you would like us to determine what’s going on, please submit the Candidate form here: https://regenexx.com/the-regenexx-procedures/back-surgery-alternative/ or call 866 684 9919

  4. Christopher Devine

    Hi, where abouts in the states are you located? I too have neck issues with tinnitus and visual problems after looking down and up for too long. I live in the uk Scotland and was wondering what’s the most effective and quickest course of treatment? Prp or stem cell therapy

    Thanks

    1. Regenexx Team Post author

      Christopher,

      We have clinics throughout the US and a 5 internationally. The treatment depends on what’s causing the issue which is established through a Candidacy evaluation and ultimately an exam. In many cases customized platelet procedures are used. In some very specific cases, stem cells. We have a Regenexx Clinic in Brussels if that would be a help. Please see: https://regenexx.com/find-a-physician/

  5. Judi Welch

    I have osteoarthritis in my neck and occipital pain and spasms. I have vertigo when I look up or turn suddenly when my neck is tight. My ENT gave me Brant Danoff vertigo exercises which make my neck feel awful and my vertigo worse as I think it is cervicogenic more than ear ! Where are you located ?. I am in LOs Angeles. I hate this condition !
    Thanks !

    1. Regenexx Team Post author

      Judi,
      Sounds that way. We’d need to examine you. Here is our Los Angeles Regenexx Provider: https://www.healthlinkcenter.com/?utm_source=regenexxreferral&utm_medium=webreferral&utm_campaign=regenexxlocations

  6. Mafalda

    Hi, I feel some type of hard to explain dizziness that comes in fases, and many doctors cant explain it, but usually it gets better after some physiotherapy sessions. It feels like I’m a flag, although I feel no vertigo and experience no loss of balance. Is it possible that this is neck related? I also have a lot of neck stiffness and migraines.

    Thank you

    1. Chris Centeno Post author

      Yes, it’s possible this is neck related.

      1. Susan Town

        I have already had 3 cervical levels fused, c5-6,6-7, and 7-t1. Currently dealing with facet syndrome at the upper levels with pain, spasms, and dizziness. RFA pending. Will this procedure help all of my symptoms. The spasms and dizziness are getting very hard to deal with.

        1. Regenexx Team Post author

          Susan,
          Unfortunately, fusion ultimately overloads the adjacent segments rather than addressing the problem. Please see: https://regenexx.com/blog/pain-after-neck-fusion-2/ RFA nukes the nerves that stabilize the area, so ultimately makes the situation worse.The symptoms you’ve stated suggest an upper cervical issue, but we’d need more information through a Candidacy review. To do that, please submit the Candidate form to the right of the Blog, or call 855 622 7838

  7. Anacleto Reyes Ignacio

    Lightheadedness, balance problem, pain in the neck, and dizziness are all my problems.
    I had tinitus both ears, recently I had my MRI for my brain and according to my ENT doctor everything was normal, but all my problems still affecting my daily routine. She wants me to get an MRI, and CT scan of my ears and get a VNG done, I don’t know if these the best approach

    1. Regenexx Team

      Anacleto,

      If all checks out with those tests, please contact us at 303 429 6448 to set up a Cervical Candidacy review.

  8. Andrea

    I have had dizziness and headaches for over 3 years. I woke up with dizziness in Oct 2015. Since that time, I’ve had every test you can name. I’ve also had surgeries that I was told would fix the 24/7 dizziness. I even had a craniotomy for a SSCD in June. I had a dehiscence, but it was not the root of my symptoms. I have a headache everyday along with the 24/7 dizziness. I’ve had a chiropractor recently tell me my atlas is subluxed anteriorly and rotated to the right. I am a PT and have done self treatments, including dry needling. I’ve had nerve blocks as well as so many med trials for migraine. NOTHING has helped me. Is Regenexx a reasonable treatment for someone like me? No one can figure out my diagnosis and I’m miserable.

    1. Regenexx Team

      Hi Andrea,
      These issues are notoriously difficult to diagnose and get help for, which is why we’re establishing the CCJ Instability Institute. Please see: https://regenexx.com/blog/a-case-study-of-severe-ccj-instability-and-our-picl-procedure/ https://regenexx.com/blog/candidacy-for-ccj-instability-procedure/ If you’d like to see if this issue is what’s been causing your symptoms, and possible treatment, please submit the Candidate form here: http://www.regenexx.com, or give us a call at 755 622 7838. Please not that the PICL procedure (CCJ Instability Procedure) is only done at Regenexx HQ’s in Colorado.

  9. Philip

    I have dizziness 24/7. And muscle pain. Like my thighs hurt and they are restless. I’ve been to neurologist and ent. My ent test were good. I’m scheduled for mri. But no one seems to know what’s going on with me. I’m only 30 years old. All of these problems occurred after I was really sick in December. However, i was tested for Guilin barre or however u spell it and they said I don’t have that Bc I still have all my reflexes. I have constant neck pain that goes into the back of my head. No headaches tho. Any help or tips would be great.

    1. Regenexx Team

      Hi Philip,
      We’d need to examine you to advise. We have a Regenexx location relatively close to you that could do that. Here’s their website: https://regenexx.com/sarasota/ or give us a call at 855 622 7838 for assistance.

  10. Danielle livick

    My dr told me I have knots n my kneck and head I get so dizzy I can barely stand or lay I get shakey tremors headaches no test is showing anything can it be from my kneck

    1. Regenexx Team

      Hi Danielle,
      Sorry to hear how unwell you are feeling. We’d need to examine you to answer your question. If you’d like to set up an exam, please call 855 622 7838.

  11. John Hall

    Hi

    I got a new gym programme about 3 weeks ago and it involved a lot of new workouts like pull ups and dumbbell rows all in circuits and a couple of days later I got dizzy spells with a pain in my traps on both sides and slight pain in my neck with dizziness, lightheaded and headaches in base of skull and naseau. My doctor says it is vertigo but I have been taking the stemitil tablets for the past week, I still have the dizziness and tight traps with headaches. Do you think it could be my neck?

    1. Regenexx Team

      Hi John,
      It could be, we’d need to examine you. Here would be the closest location to you: https://www.algocells.com/?utm_source=regenexxreferral&utm_medium=webreferral&utm_campaign=regenexxlocations

  12. Amalraj

    Hi Doctor,
    This is Amalraj from India, I had an shoulder surgery last weak because I had an fracture. I have stayed in hospital for 4 days.. I have taken complete bedrest.. I feel severe paining in my neck at present.. I’m normal no neck pain the the of surgery. I couldn’t able to sleep and get up from the bed.. I feel more Dizziness, headache.. Terrible dizziness. Suffering for 2fayssuddenly. I got this problem.. Kindly advice me why sudden neck pain and terrible dizziness… Please reply asap…

    1. Regenexx Team

      Hi Amalraj,
      Those symptoms are not part of normal recovery and are very significant symptoms that need to be reported to the Doctor who performed the surgery. In the future, our India Regenexx provider may be able to help deal with issues without the risks of surgery: https://regenorthosport.in/?utm_source=regenexxreferral&utm_medium=webreferral&utm_campaign=regenexxlocations

  13. Dan Hardie

    Hi there. I woke up dec 16 2018 with vertigo. It has been off and on ever since. I’ve not been able to work. I feel like clenching my jaw hard and forcing it through my head helps. Also trying to focus on words when typing even this, or reading makes my head spin. Sometimes headaches others not. Bp seems to bounce all over the place now . I wear a toque as the pressure on ears seems to help sometimes. I am light sensitive . I feel nauseous most of the time . Neck is tight . Ringing in ears . This is a debilitating horrible feeling . I feel like my life was just snatched from under me. Any thoughts on what might help .

    1. Regenexx Team

      Hi Dan,
      Do you have a connective tissue disorder like EDS?

  14. linda mcgettigan

    hi,

    It started 3 years ago for me. i woke up with the weird feeling in my head and feeling really sick with diarrhoea. The feeling goes up the back of my neck and up to the full back of my head, i have gotten worse over the last 3 years and i am now at the stage that i spend most of my time in bed suffering and am starting to feel depressed. i was a really out going bubbly person and have my own tanning shop but since the last 3 months i have been paralysed to bed. I have had a brain Mri and they found a cyst but say they are 100% sure its not causing the problem.
    Need advice ASAP

    1. Chris Centeno, MD Post author

      Sounds like your upper neck needs to be checked out as a cause.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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