Cervicogenic Dizziness: What It Is, Why It Happens, and How to Treat It
- Ana Souto
- 3 days ago
- 5 min read
Cervicogenic Dizziness: What It Is, Why It Happens, and How to Treat It -A clear, evidence‑based guide for clinicians and patients.
Dizziness is a common complaint among adults, describing sensations such as lightheadedness, disequilibrium, or a feeling of heaviness in the head. According to the Bárány Society, dizziness reflects a disturbed or impaired spatial orientation without a hallucinatory sense of motion. Emerging evidence suggests that cervical spine dysfunction may be a major contributor to dizziness, especially when neck pain co-occurs, and other causes have been excluded. However, there is no consensus on the pathogenesis and on the diagnostic criteria, and for now, the diagnosis is based on exclusion (Knapstad et al., 2019; Li et al., 2022; Peng et al., 2021).
What Is Cervicogenic Dizziness?
Cervicogenic Dizziness arises from dysfunction in the cervical spine. Episodes typically last minutes to hours and are often triggered by neck movements or sustained cervical postures.
Common symptoms include:
- Dizziness or imbalance
- Neck pain and stiffness
- Headaches
- Visual disturbances
- Nausea
- Tinnitus
Understanding the Cervical Origins of Dizziness
The leading explanation for Cervicogenic Dizziness involves altered cervical proprioception. The cervical region contains a high density of proprioceptive receptors, especially in the suboccipital muscles. When these signals become inconsistent due to pain, trauma, degeneration, or muscle spasm, the brain receives conflicting information from the visual, vestibular, and proprioceptive systems, generating dizziness.
Reflexes That Maintain Stability
Human spatial orientation and postural stability depend on a unified body-centered frame of reference created by integrating three distinct sensory inputs: neck proprioception (head position relative to the trunk), the vestibular system (head position relative to space), and the visual system (head position relative to the environment). This multisensory integration occurs at several neural levels. To ensure the precise coordination of head, neck, and eye movements, the central nervous system integrates multisensory inputs through specialized reflex activities that can be categorized by their stabilization targets: gaze (VOR, COR), head orientation (VCR, CCR), and limb/body posture (VSR, TNR)(Happee et al., 2023; Li et al., 2022.).
1. Gaze Stabilization Reflexes
- Vestibulo‑Ocular Reflex (VOR): Stabilizes vision during head motion.
- Cervico‑Ocular Reflex (COR): Uses cervical proprioception to stabilize the eyes, becoming more evident when vestibular input is compromised.
2. Head Stabilization Reflexes
- Vestibulo‑Collic Reflex (VCR): Uses vestibular input to stabilize head posture relative to space.
- Cervico‑Collic Reflex (CCR): Uses cervical proprioception to coordinate head‑neck alignment.
3. Body and Limb Stabilization Reflexes
- Vestibulospinal Reflex (VSR): Adjusts limb and trunk muscle activation to maintain balance.
- Tonic Neck Reflex (TNR): Modifies limb tone according to head position.
The Sensory Conflict/ Mismatch Theory
Cervicogenic dizziness may occur when there is a sensory mismatch. For example, when damaged neck receptors (COR/CCR) send signals that conflict with the information provided by the eyes (visual) or the inner ear (VOR/VCR) (Happee et al., 2023; Li et al., 2022).
Mechanism of Dysfunction
Some known causes that may alter cervical proprioceptive input:
• Trauma and Pain: Whiplash or chronic pain can damage receptors and distort sensorimotor control, leading to long-term deficits even after the pain is resolved.
• Degenerative Disease: Inflammation and the growth of new receptors in damaged discs (cervical spondylosis) generate "erroneous" signals that mismatch with normal vestibular and visual data.
• Muscle Issues: Spasms or fatigue can lead to hyperactive or hypersensitive muscle spindles, particularly in the suboccipital region, which contains a high density of these sensors.
Cervical Joint Position Error Test – Key Interpretation Thresholds
The Cervical Joint Position Error (JPE) test is a fundamental tool for measuring joint position sense. It evaluates cervical proprioception by assessing the patient’s ability to relocate their head to a neutral position after active head movement, with eyes closed.
Findings by L’Heureux-Lebeau et al. (L’Heureux-Lebeau et al., 2014) demonstrate that the test's diagnostic accuracy depends significantly on the chosen threshold for a "positive" result. When a positive result is defined by an average error above 4.5 degrees, the test maintains a balanced profile, showing a specificity of 75% and a sensitivity of 72%. However, if the threshold is broadened to include any single position error greater than 4.5 degrees, the sensitivity increases to 92%—successfully catching almost all cases of dizziness—but the specificity drops to 54%.
The PhysioSensing Otoneuro System contains the JPE test and presents the final result for each movement as the Mean Angle Magnitude Error, calculated after three trials for each movement.
Evidence‑Based Treatment Strategies
Treatment is conservative and focuses on restoring normal cervical function and sensory integration (Li et al., 2022).
Manual Therapy - Helps restore joint mobility, reduce muscle tension, and normalize proprioceptive signalling (Li et al., 2022; Peng et al., 2021).
Proprioceptive Retraining
- Head Repositioning Accuracy Training (AlDahas et al., 2024; Peng et al., 2021).
- Movement Sense Training (Kristjansson & Treleaven, 2009).
- Eye–Head Coordination exercises (Peng et al., 2021; Petersen et al., 2013).
Balance training (Kristjansson & Treleaven, 2009; Peng et al., 2021).
Research indicates that programs lasting between 4 and 8 weeks lead to significant improvements in head repositioning accuracy (reduced JPE), decreased neck pain, and lower functional disability (AlDahas et al., 2024; Peng et al., 2021; Petersen et al., 2013).
Final Thoughts
Cervicogenic Dizziness is often underdiagnosed but highly treatable. By addressing cervical proprioception and restoring multisensory integration, clinicians can significantly improve patient outcomes.
Go check the Otoneuro System Product Sheet
Ana Souto
Meet Ana, a physiotherapist with a master's degree in human physiology and certified by the American Institute of Balance.
Ana currently serves as the clinical specialist at PhysioSensing, a cutting-edge Balance Assessment and training device. Her approach is firmly rooted in the latest scientific findings, ensuring that PhysioSensing users receive the most effective and up-to-date care. In addition to her role in designing tailored programs, Ana plays a pivotal role in guiding new clients through the learning process of using PhysioSensing. She also provides advanced training and support to existing customers seeking to further deepen their clinical practice knowledge and stay on top of the latest scientific advancements.
References
AlDahas, A., Devecchi, V., Deane, J. A., & Falla, D. (2024). Responsiveness of the cervical joint position error test to detect changes in neck proprioception following four weeks of home-based proprioceptive training. PLOS ONE, 19(5), e0303066. https://doi.org/10.1371/journal.pone.0303066
Happee, R., Kotian, V., & De Winkel, K. N. (2023). Neck stabilization through sensory integration of vestibular and visual motion cues. Frontiers in Neurology, 14, 1266345. https://doi.org/10.3389/fneur.2023.1266345
Knapstad, M. K., Nordahl, S. H. G., & Goplen, F. K. (2019). Clinical characteristics in patients with cervicogenic dizziness: A systematic review. Health Science Reports, 2(9), e134. https://doi.org/10.1002/hsr2.134
Kristjansson, E., & Treleaven, J. (2009). Sensorimotor Function and Dizziness in Neck Pain: Implications for Assessment and Management. Journal of Orthopaedic & Sports Physical Therapy, 39(5), 364–377. https://doi.org/10.2519/jospt.2009.2834
L’Heureux-Lebeau, B., Godbout, A., Berbiche, D., & Saliba, I. (2014). Evaluation of Paraclinical Tests in the Diagnosis of Cervicogenic Dizziness. Otology & Neurotology, 35(10), 1858–1865. https://doi.org/10.1097/mao.0000000000000506
Li, Y., Yang, L., Dai, C., & Peng, B. (2022). Proprioceptive Cervicogenic Dizziness: A Narrative Review of Pathogenesis, Diagnosis, and Treatment. Journal of Clinical Medicine, 11(21), 6293. https://doi.org/10.3390/jcm11216293
Peng, B., Yang, L., Li, Y., Liu, T., & Liu, Y. (2021). Cervical Proprioception Impairment in Neck Pain-Pathophysiology, Clinical Evaluation, and Management: A Narrative Review. Pain and Therapy, 10(1), 143–164. https://doi.org/10.1007/s40122-020-00230-z
Petersen, C. M., Zimmermann, C. L., & Tang, R. (2013). Proprioception interventions to improve cervical position sense in cervical pathology. International Journal of Therapy and Rehabilitation, 20(3), 154–163. https://doi.org/10.12968/ijtr.2013.20.3.154