Cervicogenic Dizziness

1. Blood Flow – Vascular or Autonomic Causes:

• Vertebrobasilar insufficiency (VBI) is a transient reduction in blood flow through the vertebral or basilar arteries, often due to plaque and exacerbated by head positions that mechanically compress the arteries at the cervical spine.
• How do we know if intermittent reduced blood flow to the brain is the cause of a patient’s dizziness?

• • What Not To Use: The Vertebral Artery Test (VAT) has 0% sensitivity—a person with true VBI could easily have a normal or negative VAT.
  • What To Use: Use both together!
    • History suggests VBI— dizziness provoked and gradually worsened by increased time in neck rotation and/or extension, and even more concerning if neurologic symptoms such as slurred speech develop while in this position
    • ≥3 stroke risk factors
  • Then IMAGE! Preferred methods for efficacy of VBI testing include CTA or MRA, with digital subtraction angiography (DSA) reserved as an option for complex or unclear cases.
• Autonomic dysfunction mimicking cervicogenic dizziness as an “off” or vague lightheaded feeling can include orthostatic hypotension or POTS. Bedside screening for autonomic issues can include orthostatic measures like the NASA 10 Minute Lean Test, and when in doubt, refer the patient to physicians who specialize in dysautonomia care.

2. Vestibular Issues Co-Existing with Neck Issues

• Do a full oculomotor and vestibular screening! Benign Paroxysmal Positional Vertigo (BPPV), peripheral vestibulopathy, and central vestibular conditions such as cerebellar lesions can show increased dizziness with head and neck movement. Conditions such as concussion, vestibular migraine, and persistent postural perceptual dizziness rely on criteria for diagnosis and should be identified and treated also.
• NOTE: Neck pain does NOT mean that the cause of a patient’s dizziness is “cervicogenic dizziness.”
  • Many patients with vestibular issues also have or develop neck pain. For example, in a study by Acle-Cervera et al. (2025), BPPV was associated with new-onset neck pain.
  • If neck pain and dizziness coexist, STRONGLY consider migraine! “Migraine, including vestibular migraine, is by far, the commonest cause for the combination of neck pain and vestibular symptoms.” – Bárány Society position on ‘Cervical Dizziness

3. Sensory Mismatch Theory for Cervicogenic Dizziness (CGD):

• There is no test or set of tests than can definitively rule in or out a sensory mismatch as the cause of cervicogenic dizziness.
• It remains appropriate to assess and treat neck impairments and pain whenever present. This will make it easier for patients to be successful with vestibular rehab exercises. It may also reduce dizziness or off-feeling that might be related to cervical issues themselves. (Li et al., 2022).