If you have dizziness that seems like fairly constant lightheadedness and gets worse in the evening, you may be suffering from upper cervical dizziness.
Upper cervical alignment problems in the C1 atlas bone or C2 axis bone can cause dizziness, lightheadedness, vertigo, and imbalance, and sometimes tinnitus and headaches.
To screen my patients, I check the active range of motion of their neck during the initial exam. I also perform special physical therapy tests to identify a cervical component of dizziness during a patient exam.
If a patient cannot turn their head ninety degrees to the right and left and extend their neck 75-90 degrees, then dizziness may be coming from their neck.
If one of the special tests indicates that their neck is the root cause of dizziness, I teach my patients self-care techniques and refer them to another healthcare provider who specializes in upper cervical care.
Upper Cervical Dizziness Indicators
Does your neck make noise, like a crunch, click, pop, or grind, when you turn your head side to side?
Neck noises during an active head turn may be a sign that vertigo or dizziness might be from your upper cervical area. Although some patients with upper cervical dizziness do not hear any noises in their neck when turning side to side, they may still feel neck tension.
Common signs and symptoms:
- Dizziness never really goes away, and fairly constant lightheadedness, wooziness, or floaty feeling (which may get worse sometimes)
- Tenderness or pain in the space behind the ear lobe, back of ear bone, and jaw bone on either side (see the photo at the top of this blog because she is pointing to the spot)
- Crunching, cracking, clicking, or grinding noises in your neck when you turn your head from side to side
- Can’t turn your head all the way from side to side (Limited neck mobility)
- Dizziness symptoms are relieved with ibuprofen or other non-steroidal anti-inflammatory drugs.
- Intermittent pressure or fullness in the ears
- Intermittent ringing in the ears (tinnitus)
- Pulsating dizziness in bed at night, which may change with different neck positions
- Anxiety started or got worse with the onset of dizziness
- General neck tension
- Headaches
- Recurrent vertigo
- Pressure across the crown and sides of the head that patients often describe as feeling like they are wearing an invisible swim cap
Associated Health Conditions
Upper cervical dizziness may or may not be associated with a headache. Migraines, vestibular migraines, tension headaches, and base of skull headaches may co-occur with upper cervical dizziness.
Meniere’s syndrome attacks can be triggered by upper cervical dizziness.
Recurrent BPPV may also occur in patients with unaddressed upper cervical issues. See below for more details.
Anxiety may result from upper cervical issues as well due to the neurological strain on the body.
Forward head posture may contribute chronic or worsening upper cervical dizziness. Postural retraining may be required to resolve this problem long term.
More information about possible root causes of upper cervical dizziness.
The Hidden Link Between Upper Cervical Dizziness and BPPV
BPPV Treatment can Cause Upper Cervical Problems
Upper cervical dizziness is a commonly unrecognized adverse side effect of repeated Epley maneuvers and Semont maneuvers for posterior canal BPPV.
Patients with a history of neck pain, stiffness, muscle tightness, diagnosed neck pathology, or whiplash injury are most affected by upper cervical dizziness after repeated Epleys or Semont maneuvers.
Although I find Semont to be a better choice for patients with a history of neck problems because it avoids cervical extension, both Semont and Epley maneuvers can contribute to increased neck tension, stiffness, and pain.
Learn more in this blog on six reasons for dizziness after Epleys.
Upper Cervical Problems Can Cause Recurrent BPPV
I think it’s important to figure out what you’re going to do for your neck care, to optimize your recovery.
If the alignment of your C1 and C2 neck bones is off, it can partially restrict blood flow to your ears.
Any reduction in blood flow to your ears can cause a new onset of BPPV.
For some patients with a history of BPPV, this can be a cause of BPPV recurrence.
If you don’t address the neck, your BPPV treatments could just be like getting stuck in a pit of quicksand. You seem to make progress with BPPV treatment and then the BPPV gets worse again or keeps coming back.
It’s important to get your neck care started, to restore full blood flow to both ears and reduce the risk of shedding more BPPV crystals.
I’ve personally wasted a lot of time and money seeing both chiropractors and physical therapists for many years who were nice but they did not specialize in upper cervical care.
It’s really important that whomever you see can competently assess and manually adjust the C1 bone, C2 bone, full spine, TMJ, first ribs, and shoulders.
What to Do
In this blog, I discuss who can help with upper cervical dizziness.
This blog shares strategies I use and teach my patients for relief of upper cervical dizziness.
Disclaimer
This blog is provided for informational and educational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.
Thank you for this interesting post.
My physical therapist, an ENT and I all feel my neck plays a major role in my balance and vertigo problems. The problem is finding a doctor who understands this and knows what to do. My diagnosis is central in nature – Vestibular Migraine, PPPD and cervicogenic dizziness. What kind of doctor should be following me and helping? What is the answer for these kinds of neck problems?
Hi Karen,
Great questions!
I have two more blog articles on this topic that I will publish sometime this month, January 2023.
The article on who can help with upper cervical dizziness will be published on this same website, VertigoDetective.com.
The article on what may be a root cause of upper cervical dizziness will be published on my other website, BetterBalanceInLife.com.
Be sure to check back to both websites for further information on these topics.
I am sorry for what you are going through and I hope you find relief soon!
I have been seeing my ENT for BPPV vertigo for a few months (had it over 4 times in past 3 months). I also had the Omniax chair therapy which showed nothing. Yesterday my son and I were painting, and I had alot of head movement but was ok. When I woke up this morning my vertigo was full blown, spinning, vomitting, it was terrible. I also had some neck pain, stiffness (have had this for awhile). I am wondering if I should see a chiropractor since it seems as if everytime I am getting vertigo, my neck seems to hurt. I need something else besides the epley manuever, (that works only for a short time).
Appreciate any suggestions you can provide.
Hi Charlotte,
I am sorry to hear about this vertigo recurrence!
Many patients need BPPV treatment and cervical care.
You can use this blog to search for a vestibular provider.
This blog talks about who can help with neck stiffness and cervical dizziness.
I have many other blogs on BPPV and cervical issues, both on this website and my other blog BetterBalanceInLife.com. I encourage you to search key words on both websites to find related content.
Best wishes!
Dr. Bell: Do you recommend upper cervical chiropractors who practice orthospinology and use the laney instrument to do adjustments? I have been suffering from vertigo for 11 weeks now, and can no longer live like this. It’s hard for me to do daily tasks or even sit and watch TV because I always feel like I’m going to fall over, dizzy, and unsteady. My brain MRI came back fine, and I did vestibular therapy for about 6 weeks, but my case has not gotten better. The vestibular therapist said she could no longer help me and referred me to another therapist to see if they would have better luck. The neurologist at the ENT practice who diagnosed me with BPPV is also baffled and said that perhaps I should see a cardiologist (which I will in about a week). But my neck quickly tenses up when I’m sitting and my dizziness/unsteadiness never really seems to go away, so I was wondering if an upper cervical chiropractor could be my next step, but there are only two in my area (San Antonio), and they specialize in orthospinology and use the laney instrument. Do you ever do video consults or do you have any vertigo specialists you recommend in the San Antonio area?
Hi Diana,
I am sorry to hear what you are going through!
Regarding what type of care I recommend for cervical dizziness, you can click here to read an article I wrote on that topic.
Also, you may want to consider consulting a more experienced vestibular PT provider to see if that can still help.
I do not offer telehealth, nor can I advise you in Texas. I am licensed in California.
However, I can suggest contacting my very experienced vestibular physical therapy colleague in Texas, Bridgett Wallace. Click here for her website.
Please tell Dr. Wallace that I referred you. She offers telehealth if you cannot get to her clinic in person.
Best wishes!
I have been living with severe vertigo, tinitus, headaches, neck and ear pain for two years now. I had a head trauma around four years ago and I’m wondering if this was the catalyst. At first I thought I was in perimenopause but now I’m convinced (after reading this article) that it is due to my neck. I’m in the UK and I’ve had brain scans, seen a cardiologist, been on numerous medications and tried vestibular therapy- none of which help.
Are there any exercises you can recommend to help alienate my symptoms. I have two young kids and I’m struggling to get them to school (I’m a single mum) and I struggle daily.
Hi Carla,
I am sorry to hear this! It would be irresponsible for me to try to guess what exercises you might need without evaluating you in person, so I am not able to offer an opinion on that.
However, I hear from so many people like you from all over the world on a continual basis that I was inspired to write a book to try to help you by sharing what I have learned in over twenty years of clinical practice.
You can buy your copy of my book on Amazon here.
I hope that is helpful!
I also have over 200 free blogs here and more blogs on BetterBalanceInLife.com. You can search key terms or use the blog categories to find relevant articles.
I have a YouTube Channel here with free helpful videos on various topics.
I am so sorry for what you are going through and I hope you feel better soon!