Dizziness and Neck Pain: The Inner Ear Is Only Part of the Picture
POSTED ON 11/7/2017 IN Spine BY Christopher Centeno
Did you know that your neck can make you dizzy? Most patients don't know that dizziness and neck pain can be connected, and many physicians miss this diagnosis. Why? Both patients and doctors think inner ear or brain when dizziness occurs. However, this symptom points to one very specific part of your neck.
The Cervical Spine and Its Link to Dizziness and Neck Pain
The uppermost part of the spinal column, called the cervical spine, consists of 7 vertebrae with cushioning discs in between each level and 2 joints at the back of each vertebra (14 total, called facet joints). Together with muscles, ligaments, tendons, and nerves, these structures in the cervical spine support and precisely control movement in our neck. When we experience dizziness and neck pain, more often than not it's from the upper neck (dashed box). There are actually three different systems that work closely together to keep us balanced. These are the upper neck, the eyes, and the inner ears. Via the nerves that come from the upper neck facet joints and muscles, the upper neck provides position-sense information that coordinates with our eyes and inner ear. The purpose is to assure that we have multiple systems that can keep us upright, walking, and level-headed, and, indeed, all of the input communications must properly sync and agree for you to maintain normal balance and for you to remain in control of your positioning, both physically and mentally. In other words, when these three systems don't jive, even if it's just one weak link with information coming in that doesn't agree with the other two, dizziness can occur. In addition, the facet joints in this area of the cervical spine can refer pain to the head, which is why headaches can also be a common accompanying feature of dizziness and neck pain.
Causes of Neck Pain, and Treatment Solutions
Addressing the source of the upper-neck pain is the key to relieving the pain and eliminating dizziness. The goal is to avoid surgery, such as a cervical fusion that permanently disables neck movement and comes with many side effects and lengthy recovery times. There are many injuries and conditions that can cause neck pain, and effective nonsurgical treatments will depend on the issue. The simplest solution might simply be physical therapy; however, if this doesn't relieve dizziness and neck pain, there are more treatment solutions that follow. Trigger-point dry-needling can be effective because oftentimes the bad input on balance is coming from muscle trigger points here. This involves inserting small acupuncture needles into tight or weak knots of muscle, which are caused by irritated nerves that supply the neck muscles. Trigger-point injections that involve injecting substances like local anesthetics and steroids can be myotoxic, or toxic to the muscle, and should be avoided. The facet joints in the upper neck can also become injured or arthritic. If you have a chronic headache along with neck pain and dizziness, a damaged facet joint could be the culprit, and these can usually be treated by injecting the upper-neck facet joints with platelet rich plasma (PRP). The ligaments in the upper neck can become stretched or damaged due to an injury or disease, and this can cause both the head and upper neck to have too much movement. This puts pressure on the nerves and causes neck pain, headaches, and dizziness. Tightening down these ligaments with a prolotherapy or PRP injection may help. If the damaged ligaments are causing a more severe craniocervical junction (CCJ) instability, this requires a more complex injection procedure.
A Word on Steroid Injections and Radiofrequency Ablation Procedures
Anti-inflammatory steroids and radiofrequency ablation procedures are both common ways to treat neck pain due to facet joint and other injuries. Steroid injections are riddled with side effects, are toxic to stem cells, and can be less and less effective at eliminating pain with each treatment. A radiofrequency ablation (RFA) procedure uses a heated probe to burn away the nerves around the damaged facet joint. The thought is that by destroying the nerve this will stop the pain because the pain can no longer be transmitted to the brain. There is research to support RFA for chronic neck pain due to a damaged facet joint, but burning nerves creates some problems, including creating more damage in the joint since you can't feel the pain (a Charcot joint), more-frequent and long-term treatments to address returning pain, and more severe pain when it does return. The upshot? Upper-neck problems are a common cause of dizziness. So if you have neck problems, headaches, and dizziness, make sure that an expert in nonsurgical neck treatment takes a close look!
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