Dizziness / Vertigo / Vestibular Disorders
How Upper Cervical Care Relates to
Dizziness / Vertigo / Vestibular Disorders
The vestibular system includes the eyes, inner ear, upper neck joints and brainstem, which collaborate to control balance. Damage to this system can result in sensations of vertigo or dizziness, which can range from mild, transient episodes to severe, extended attacks. Often, additional symptoms such as nausea, vomiting, malaise, hearing loss, tinnitus (ear ringing), and a feeling of ear fullness or pressure accompany the dizziness / vertigo. Types of vestibular disorders include:
- Benign Paroxysmal Positional Vertigo (BPPV) - dizziness triggered by specific changes in the position of the head and neck, such as tipping the head up or down, lying down, turning over or sitting up in bed;
- Meniere's Disease - sensation of vertigo along with fluctuating hearing loss, ringing in the ear (tinnitus), and sometimes a feeling of fullness or pressure in the ear;
- Disembarkment Syndrome - the illusion of movement felt as an after effect of travel by ship, boat, train or plane; difficulty maintaining balance; extreme fatigue; and difficulty concentrating ("brain fog");
- Labyrinthitis - sensation of vertigo with inner ear involvement, and sometimes ringing in the ear (tinnitus), hearing loss and a feeling of fullness or pressure in the ear;
- Cervicogenic Vertigo - dizziness accompanied by neck pain;
- Migraine Associated Vertigo (MAV) - attacks of dizziness and imbalance accompanying a migraine headache.
The body of medical literature detailing a possible trauma-induced (concussion, whiplash, etc.) etiology for vestibular disorders, or at least a contribution, is substantial.1-16 In fact, researchers have pinpointed a mechanism for certain types of vertigo originating from neck dysfunction, also known as "cervicogenic vertigo".16-28 According to medical literature, vertigo can be elicited by hyperactivity of spinovestibular afferents (irritated joints in the upper neck). Since the cervical afferents (neck joints) assist in the coordination of the eye, head, and body, spatial orientation and control of posture, a stimulation and/or lesion in these structures can produce vertigo.16-27
Following the trauma, vestibular disorders can be triggered immediately or they can take months or years to develop. The purpose of upper cervical chiropractic care is to reverse the trauma-induced upper neck injury, thereby reducing irritation to the nerves that trigger vertigo. While many vertigo sufferers recall specific traumas such as head injuries, auto accidents or falls, some do not. An evaluation is necessary in each individual's case to assess whether an upper cervical injury is present and whether benefit from upper cervical care can be achieved.
By 2017, Dr. Elster has cared for approximately 250 patients with vertigo disorders including Meniere's disease, labyrinthitis, benign positional vertigo, disembarkment syndrome, etc. All patients showed evidence of trauma-induced upper cervical injuries during examination (upper cervical radiographs and digital infrared imaging). Many patients recalled specific incidences of trauma (auto accidents, falls, concussions, whiplashes, sports injuries) that could have caused their upper cervical injuries while some did not.
Research Articles and Publications
- "Upper Cervical Chiropractic Care Corrects Dizziness / Vertigo" by Erin Elster, DC. Women's Magazine. January 2000.
- "Whiplash: Information For Drivers, Pedestrians, and Athletes" by Erin Elster, DC. The Atlas Files. June 2000.
- "Chronic Vertigo Sufferers Find Relief With Upper Cervical Chiropractic" by Erin Elster, D.C.
- "Sporting Accidents Among Vertigo Culprits; New Treatment Promising" by Erin Elster, DC, MAUI NEWS, January 24, 2014
- "Healthy and Well-Adjusted" By Cindy Schumacher, Maui Weekly, December 2013
- "Help For Chronic Motion Sickness" by Erin Elster, DC, Lahaina News, April 23, 2015
- "An Alternative Approach for Vertigo" By Erin Elster, DC, Lahaina News, January 28, 2016
- "Get Your Head On Straight" By Erin Elster, DC, Lahaina News, March 31, 2016
- Fitzgerald DC. Head trauma: hearing loss and dizziness. J Trauma 1996 Mar; 40(3): 488-96.
- Hornibrook J. Immediate onset of positional vertigo following head injury. NZ Med J 1998 Sep 11; 111(1073):349.
- Said J, Izita A, Gonzalez A. Tinnitus and post-traumatic vertigo- a review. Int Tinnitus J 1996; 2: 145-50.
- Merior P, Marsot-Dupuch K. Imaging of post-traumatic tinnitus, vertigo and deafness. J Radiol 1999 Dec; 80(12 Suppl): 1780-7.
- Kessinger RC, Boneva DV. Case study: acceleration/deceleration injury with angular kyphosis. J Manipulative Physiol Ther 2000 May; 23 (4): 279-87.
- Katsarkas A. Benign paroxysmal positional vertigo (BPPV): idiopathic versus post-traumatic. Acta otolaryngol 1999; 119(7): 745-9.
- Gusev EI, Nikonov AA, Skvortsova VI. Treatment of vertigo in patients with vascular and traumatic cerebral injuries. Zh Nevrol Psikhiatr Im S S Korsakova 1998; 98(11): 19-21.
- Godbout A. Structured habituation training for movement provoked vertigo after severe traumatic brain injury: a single case experiment. Brain Inj 1997 Sep; 11(9): 629-41.
- Fischer AJ, Verhagen WI, Huygen PL. Whiplash injury. A clinical review with emphasis on neuro-otological aspects. Clin Otolaryngol 1997 Jun; 22(3): 192-201.
- Claussen CF, Claussen E. Neurootological contributions to the diagnostic follow-up after whiplash injuries. Acta Otolaryngol Suppl 1995; 520 Pt 1: 53-6.
- Elies W. Cervical vertebra-induced hearing and equilibrium disorders. Recent clinical aspects. HNO 1984 Dec; 32(12): 485-93.
- Lehrer JF, Poole DC. Post-traumatic Meniere's syndrome. Laryngoscope 1984 Jan; 94(1): 129.
- Paparella MM, Mancini F. Trauma and Meniere's syndrome. Laryngoscope 1983 Aug; 93(8): 1004-12.
- Conrad B, Aschoff JC. Trauma as the cause of Meniere's disease. Nervenarzt 1976 Jan; 47(1): 49-50.
- Otte A, Ettlin TM, Fierz L. Cerebral findings following cervical spine distortion caused by acceleration mechanism (whiplash injury). Schweiz Rundsch med Prax 1996 Sep 3; 85(36): 1087-90.
- Mallinson AI, Longridge NS. Dizziness from whiplash and head injury: differences between whiplash and head injury. Am J Otol 1998 Nov; 19(6): 814-8.
- Galm R, Rittmeister M, Schmitt E. Vertigo in patients with cervical spine dysfunction. Eur Spine J 1998; 7(1): 55-8.
- Gimse R, Tjell C, Bjorgen IA. Disturbed eye movements after whiplash due to injuries to the posture control system. J Clin Exp Neuropsychol 1996 Apr; 18(2): 178-86.
- Erlandsson SI, Eriksson-Mangold M, Wiberg A. Meniere's Disease: trauma, distress and adaptation studied through focus interview analyses. Scand Audiol Suppl 1996; 43: 45-56.
- Soustiel JF, Hafner H, Chistyakov AV. Trigeminal and auditory evoked responses in minor head injuries and post-concussion syndrome. Brain Inj 1995 Nov-Dec; 9(8): 805-13.
- Davies RA, Luxon LM. Dizziness following head injury: a neuro-otological study. J Neurol 1995 Mar; 242(4): 222-30.
- Kortschot HW, Oosterveld WJ. Otoneurologic disorders after cervical whiplash trauma. Orthopade 1994 Aug; 23(4): 275-7.
- Schwaber MK, Tarasidis NG. Labyrinthitis ossificans following post-traumatic hearing loss and vertigo: a case report with antemortem histopathology. Otolaryngol Head Neck Surg 1990 Jan; 102 (1): 89-91.
- Scherer H. Neck-induced vertigo. Arch Otorhinolaryngol Suppl 1985;2:107-24.
- Brandt T. Cervical vertigo- reality or fiction? Audiol Neurootol 1996 Jul-Aug;1(4):187-96.
- Reker U. Function of proprioceptors of the cervical spine in the cervico-ocular reflex. HNO 1985 Sep; 33(9): 426-9.
- Tjell C, Rosenhall U. Smooth pursuit neck torsion test: a specific test for cervical dizziness. Am J Otol 1998 Jan; 19(1): 76-81.
- Hinoki M, Niki H. Neuroltological studies on the role of the sympathetic nervous system in the formation of traumatic vertigo of cervical origin. Acta Otolaryngol Suppl 1975; 330: 185-96.