Cervicogenic Vertigo

Hey Christine - sorry about that. I did get the names mucked up. Sorted.

Dizzyizzy - excellent post. Thanks for that. I’m in complete agreement with everything you said. You’re right that there are many mainstream treatments that lack robust evidence. For example, there’s only weak evidence supporting the use of SSRIs for migraine relief and no RCTs yet on MAV and SSRIs (though I am told Tusa’s lab is running an RCT now on this with paroxetine). For the latter we have been basing it on “expert opinion” from Dr Baloh, Tusa, and Newman, and results from people here on this forum and others. The difference is that there’s at least plausibility in this sort of treatment: 1) there’s a mechanism as in serotonin modulation which we know plays a role in migraine and 2) that it’s supported by someone like Baloh who thoroughly understands the science (and genetics) of migraine and the limitations of current treatment options and 3) the data is still being collected. Baloh will tell you that if you can reduce the frequency and intensity of migraine by 50%, you’ve hit gold. You’d never hear him claiming a migraine cure or a 97% success rate because it doesn’t exist (yet).

Now, then we have the likes of Dr Chiropractor promoting his treatment that has been rigourously tested over and over again for decades now. Been there done that and the results are in. It is either not effective at all, no better than placebo, or has some effect for lower back pain just like physiotherapy. And so Simon Singh called their bluff in the UK as you pointed out publishing his article “Beware the spinal trap” when they made some quack claims across the UK about treating children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying. But no, the Straights and Mixers will keep on spinning their chiropractic woo (e.g. NUCCA) and will continue to do so for another hundred years with all kinds of intricate explanations that sound compelling. You’d think by now they would have lots of evidence to draw on but it isn’t there of course beyond anecdote. It always amuses me that when you ask these guys from which hole they pulled their numbers, they always go silent like a winter snow fall. Still waiting for those research references to show that his research affected the Merck manual … Pubmed was a blank page when I searched out his name.

Best … Scott

i find that chiropractors are not open minded enough.
my chirporactor promised me the world and delivered absolutely nothing but false hope.
they only know a small percentage about the human body… but think all problems stem from that.
it’s no wonder doctors have no respect for them.
I’m sorry for offending you but i have had nothing but bad experiences with chiros and you’re not helping.
statistically, you are saying you can cure 97% of all of us here without medication etc. WOW you must be a miracle worker!

A couple of notes from my personal NUCCA experience/experiment:

  • The practitioner seemed genuinely surprised at his failure to fix me. He found me to be an anomoly of some sort and took additional x-rays on at no charge in his attempt to figure me out. I think he was sincere, but I don’t think he was going to be able to “fix” me. Of course he wanted to keep trying but I decided to hang onto my money.

  • Immediately after one adjustment, I experienced MAV symptoms I hadn’t experienced in at least a year including what I call the “funhouse” where the floor appears to be rolling.

  • I definitely do have whiplash damage to my neck. I definitely don’t think this is the cause of my migraine, but believe it could contribute to my symptoms along with a myriad of other triggers: hormones, weather, food additives, sleep issues, etc. Therefore, at most, chiropractic treatment could relieve one of my triggers, but since it didn’t after five adjustments, I’m hanging onto my money.

I don’t know if this post added anything, but this is such a crazy thread, I thought I would join in. :stuck_out_tongue:

Thanks for the input guys and your honest appraisal of NUCCA Marci.

Well, it looks like the consensus from those who contribued to this thread apart from Spinning Man is that chiropractic is what the evidence says it to be and possibly worse for MAV. For some it made symptoms worse, for others it did ziltch and for some (like myself) I get some relief from neck tension – sometimes when I use it as a last ditch attempt. It hasn’t always worked especially when neck pain was non-stop from SSRI reductions. And that’s all I expect from it even though I’m probably crazy having my neck cracked … I do think the guy I see (20+ years experience) does know how to do this without killing people so I trust him for spinal manipulation in the same way a Reformer Chiropractor would practice. If my guy starts talking about innate energies, subluxations and 3-day green apple diets, I go into sleep mode just like my Mac when I close the lid.

As for the muscular triggers (where this thread started). I can’t see why that is not a valid trigger if neck muscles are all knotted up as the literature seems to show. But a massage (or physiotherapy) will probably achieve the same relief as long as it doesn’t rev up dizziness in the process.

Scott :slight_smile:

Hey guys,

Scott I think you tied up this thread very neatly. I just wanted to add one more post in response to Marci’s.

Marci I think your post articulated and summed up my own thoughts on this whole thing. Those of us with migraine and the specialists in the field “get” that migraine is not “caused” by one thing (eg poor neck alignment) nor can it by “cured”. I think you are spot on that there are a whole range of triggers, (NOT causes) including for some, neck problems. As migraineurs we try and manage our triggers and symptoms as best we can - generally with a whole suite of techniques including diet, sleep, exercise and medication and for some, chiro, massage or other physical therapies. Chiropractors, or any other practitioners (of anything) who think that migraine is caused by one thing and can be cured by another are missing the point entirely and selling false hope.

Here endeth the sermon (down graded from previous rants) :smiley: .

Vic

— Begin quote from “jennyd”

My Best friend Lisa had a friend, who died during a neck adjustment, of stroke.
Before this Lisa was “chiro mad” for her back probs, she has never seen another chiro since.
Very sad indeed.
Prior to this, I had about 15 adjustments, with a family friend chiro, he promised the world and I gained nothing but extra dizziness and an empty pocket…

J

— End quote

I believe Hain mentions this possibility on his website.

People keep telling me to see a chiro, and I will admit one did help me years ago with sciatica pain in my leg. My leg. When it comes to my head I’m not nearly as confident, and I think the placebo effect may be at work here than actual “cures.”

Hi all,
my 2 cents:
I LOVE chiropractic treatment. It’s helped my neck/shoulders back etc…from years of working as a hair stylist. HOwever, I think all my MAV stuff stems from hormone/neuro stuff, so totally unrelated. My chiro wants me to do
traction, as I have no curve in my neck (Occupational stuff along with a rear end collision years ago). I have been reluctant to try it. He thinks it could help my dizziness…I think some people might get help from this sort of thing, and I
admit I got pretty curious when reading previous posts in this thread from the Doc, but I don’t think the two are related, even though “dizziness” a common link.
Has anyone noticed that every drug for all of this stuff says “may cause dizziness” on the label? I cringe and then have to laugh when I read it…how would i ever know if it did? I’m dizzy every day!!
Hugs,
Kelley

The subject matter of Cervicogenic vertigo has drawn me into this conversation. My MAV may not be MAV!!!

A well known ENT at Harvard (he is on the discussion forum of this site) recently diagnosed me with MAV. Ive been having whirling vertigo episodes (always to the right) - 6-12 a day - since January 2010. Other complaints include a lot of tension headaches, stiff neck, tinitus (left only), anxiety (where there was none before), brain “fog” on the left side that is constant (sumatriptan wipes it away for a day or so, then it come back). Along with the brain fog, I have become super sensitive to visual and audio stimuli. Vision in my left eye is somewhat blurred. Can’t tolerate visual patterns, say in carpet, or audio patterns such as a thumping base or tapping fingers. These things produce anxiety and increased “fog”. The anxiety causes me to stiffen my shoulders. I find that I want to hold my head still, usually by placing my left hand on the base of my skull. Somehow I feel more “steady” wiht my hand there.

After several months with ER docs (CT normal), Family doc and holistic approaches (accupuncture, massage), blood work looking for hormonal or thryroid issues, many different drugs including a week of steroids, I finally went to one of the worlds best ENTs at Mass Eye and Ear where the diagnosis was either Meineres or MAV. As I am deaf in the left ear since childhood, we decided to try intratympanic gentamicin injection - it did nothing, so the second choice was MAV. The treatment was Celexa and strict anti-migraine diet. Also using sumatriptan on severe cloudy head days, antivert (does nothing but make me sleepy) and lorazapam, which takes the edge off but is no cure.

Returned to ENT after two months of diet - no improvement, still cant drive, trouble thinking, lots of vertigo. So he added Nortripyline 10 mg, escalting every two weeks. In the meantime, I told the ENT about my neck stiffness and desire to investigate - eg, was the neck pain a symptom or a cause. He sent me to “The Spine Center” at another hospital. Here I met a physical medicine and rehab specialist whose specialty was cervical spine. After an MRI that was unremarkable, his examination produced the diagnosis of FACET JOINT inflammation and cervicogenic headache. He said the diagnosis could be easily confirmed by an injection of a short acting pain reliver (lidocaine) into the FACET JOINT at C2-3 and C3-4. So the next day I had the lidocaine injection, which was guided by xray.

Within 15 minutes, my entire world returned to normal. No headache, no vertigo, cloudy foggy head clear as a bell. I could think, my blurred vision cleared up and it was as if I was “normal” again. He said this confirms the diagnosis. Sadly the effect is temporary, and by the end of the day, all of my symptoms returned one by one.

The next step will be cortisone injections into the FACET JOINT - same loations, two injections two weeks apart.

Has anyone here tried this treatment? The diagnositic injection was so promising that I have hope of a return to normal life!!!

Thanks
greence

Greence - sorry, but I do not have an answer to your question. Can you please let me know what doctor you were seeing at mass eye and ear who dx you with MAV or menieres?

Hi MAV Lisa,
My ENT is Dr. Steven Rauch, whom I respect a great deal. He referred me to the Spine Center at Newton Wellsley, where I met Dr. Omar El-Abd, who is head of cervial intervention for the spine/pain clinic.
Both physicians have been great to work with. For me the debate boils down to which is the cart and which is the hoarse - does the migraine/vertigo make my neck become stiff/painful, or does the neck cause the headache/vertigo.

it feels like the chicken/egg problem… and for me, I jusst want it to go away regardless of why it started!

Greence - thank you so much for getting back to me. I actually have seen Dr. Rauch, but am currently being treated by Dr. Priesol, also at m ass eye and ear. When I saw Dr. Rauch, his first line treatment was Nortriptyline. I am so interested in his use of Celexa now, as even in the q and a section in this forum, he said that he does not use SSRIs for MAV. I guess he made some changes since I met with him. Just wanted to clarify was celexa prescribed to treat MAV? did he recommend this over nortriptyline? thanks so very much, and I wish you much luck in figuring things out

Hi Mav Lisa,
On Dr. Rauch, I was shocked at his statements that he does not use SSRIs. He absoletely prescribed Celexa to me, starting at 10 mg and moving every two weeks. I am at 30 mg now, but have not seen any impact on my condition. Not sure how to interpret that he presscribed SSRIs for me. Either he sees my case differently (hysterical woman in need of SSRI???) or recent literature has persuaded him to view SSRIs differently

I agree this must be a catharsis for him as he has never before shown any interest in SSRIs, only tri cyclics, specifically nortryptaline, is his favorite.

But as I said, I am feeling very optomistic about cervicogenic intervention using cortisone. there is some good literature, including placebo controlle studies to support the theory. I am a scientist (chemist) by training, and am an entrepreneur in the bio=pharma space - so I am familiar with medical literature. I remain optomistic about this diagnosis… wish me luck.

Greence - thanks again for response. best of luck to you!

Hi Greence,

You and I are in a very similar situation. Let me tell you what I think is probably going on for you:

  1. Migraine is the root cause of your problem.
  2. When you have attacks, you get “neck migraines” which means your neck is under attack as the nerves and blood vessels down there react. The result is pain in the muscles and tension and spasms ensue.
  3. Over time the tension causes the cervical spine joints to “jam” up and movement is restricted. When the C2 joint gets jammed and affected it causes all kinds of problems that are referred to the head such as brain fog, inability to think clearly, poor memory, and dizziness. Other affected joints all cause problems when they don’t move correctly.
  4. I think the aggravation at C2 somehow aggravates either MAV or the nerves of the inner ear and can causes dizziness. I’m not sure it’s necessarily “cervicogenic” in the way it is described in the literature.

Anecdotal evidence for point 4: I recently saw a physiotherapist for work on my very seized up neck due to neck migraines. I’ve had unrelenting headaches and pain for months now. The initial result was HUGE. I was clear in the head and the fog lifted as did the headache. Pain in other parts of my neck and at the occiput dropped off significantly. When the vertabrae are jammed up, other muscles in the area react with spasms and cause more pain. Tension in the upper back also contributes. It’s a great big cluster**** of things that happen. So none of the physio’s work caused me dizziness but over the weekend when I felt stiff in the neck again I did what she did but too hard by palpating C2. The result was dizziness which lasted all day yesterday. I felt very sick indeed. I’m leaving it alone from now on and will leave it to the physio.

So in a nutshell: you have migraine which you need to establish the triggers for. When you are “migraining” your neck is affected which causes the joints to seize up. Seized joints causes a whole cascade of other things to happen and is of itself a migraine trigger (pain triggers migraine). When you were given the injection you temporarily relieved the inflammation and tension at the joint and clarity returned. In my opinion, you need to stop the migraine from causing the neck tension which will stop the joints from seizing up and you will not need injections. In addition, you need to keep your neck as loosened up as possible which means frequent breaks from computer screens and specific neck stretching.

Currently I’m having a very hard time controlling triggers and an even worse time trying to find a drug I can tolerate. But the above is my current working hypothesis and I think it’s right this time. Rauch was correct I think when he nailed MAV for you. The xrays found nothing unusual because you just have migraine messing with you. I can trigger a neck migraine in 30 minutes if I eat a forbidden food. Sometimes that will include inflammation of the joints too and then comes the fog and all sorts of additional pain.

I wasn’t clear on what you said previously but Celexa is used by Robert Baloh for MAV and is his current favourite med. There are no RCTs to verify it’s use in migraine but expert opinion and the results people here have had on it (including me) make it a good choice. Rauch’s favourite is Nori and he usually tried that first. He has little experience with SSRIs for MAV but may now be using them – perhaps from reading things here or after consulting Baloh.

Let me know if this all rings true to you.

Best … Scott 8)

Hi Scott,

I, too, suffer from what you called “neck migraines”. I am wondering if yours are only triggered from food or if you find that emotional stress can trigger it as well?

Thanks,
Kim

Hi Carolyn,

I know it’s been more than a few moons since you last wrote :wink:.

I wanted to check how the cervical interventions turned out for you? Was it your cervical spine or MAV that was the root of your issues, after all? If something helped (which I hope did :slight_smile: ), can you please share what?

Thanks!

Asli

Interesting post. Neck migraines is definitely a symptom of the migraine attacks you’re having. I have read articles on some websites that back this up on the web.

The Journey of Upper Cervical Chiropractic Research carried out a survey of 300 participants and reached the following conclusion:-

“All patients with a history of vertigo should be questioned about a history of trauma, especially whiplash from an automobile accident, sports injury or serious falls . Patients often forget these accidents, thinking that they were not hurt because they did not break any bones and were not bleeding. All films; MRIs, CT Scans and x-rays, should be taken with the patient in a weight-bearing position, seated or standing, not lying down. Patients with a history of both vertigo and trauma should be referred to an upper cervical specific chiropractor for examination ."

I’m personally very dubious about this as a cause of vertigo. What would be the aetiology?

Far more likely whiplash or head trauma could injure the inner ear or cause a long lasting issue with displaced otoconia or fluid balance imho.

I suspect most real vertigo is inner ear related as that is the central sense organ for that sensation.

So how come when my wife pushes on my back to pop it while I lay on the floor belly down, does sometimes my vertigo and dizziness actually decrease substantially. I have used a handheld massager to actually bring myself out of a few episodes. I have had the twist your neck chiropractic adjustments turn into some of my worse nystagmus and vertigo episodes I have had… I had to go back to an upper cervical chiropractor to adjust me and then I get better, mind you I drive or we’ll in that state, get driven to see upper cervical chiro 1.5 hours away.

Cervical vertigo is real to me in my experience.

Anyways, I have related my neck tightness and migraines triggers to a lealy gut. If this sound like you there’s much to explore as l-glutamine has helped me so much and I really wonder if you all have any experience with this?