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Many readers would be familiar with the term ‘cervicogenic vertigo’ to mean neck-related vertigo or dizziness. In simple terms, this disorder has been defined as dizziness/vertigo caused by neck pain and/or stiffness. By implication, the vertigo/dizziness should resolve by treating the neck pain/stiffness. This diagnostic entity has therefore been called into question by several neuro-otologists for several reasons. It is known that several common vestibular disorders can be triggered by head movements. Isolating movement of the neck from head movement is often difficult in normal day-to-day life. The Bárány Society Classification Oversight Committee (COSC) conducted an extensive literature review of the controversies surrounding this diagnostic entity. To determine if the panel could come up with diagnostic criteria for cervical dizziness, they evaluated several hypotheses for neck-induced dizziness such as the somatosensory input hypothesis, triggered migraine hypothesis, trigeminal hypothesis not invoking migraine, neurovascular hypotheses of Barre and Lieou and carotid sinus syndrome and associated syncope-mediated hypotheses. In addition, clinical interventional studies were reviewed extensively. They concluded that “based upon the so far published literature, the panel takes the view that the evidence supporting a mechanistic link between an illusory sensation of self-motion (i.e. vertigo – spinning or otherwise) and neck pathology and/or symptoms of neck pain - either by affecting the cervical vertebrae, soft tissue structures or cervical nerve roots - is lacking.” In their view, “when a combined head and neck movement triggers an illusory sensation of spinning, there is either an underlying common vestibular condition such as migraine or BPPV or less commonly a central vestibular condition including, when acute in onset, dangerous conditions (e.g. a dissection of the vertebral artery with posterior circulation stroke and, exceedingly rarely, a vertebral artery compression syndrome)”. They identified migraine and vestibular migraine to be by far the commonest cause for the combination of neck pain and vestibular symptoms. Having concluded that they are unable to support the diagnosis of cervical dizziness, the authors offered useful suggestions for researchers to consider including strict inclusion and exclusion criteria that address all the confounds. For robustness, future studies should be multicentre, randomised, blinded controlled clinical trials with any placebo-controlled treatment requiring at least a one-year follow-up.

The Bárány Society position on ‘Cervical Dizziness’.
Seemungal BM, Agrawal Y, Bisdorff A, et al.
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Victor Osei-Lah

Bournemouth, UK.

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