Hi there.. this is what the doctor wrote..

 

"THis patient may have a trigger point in the sternocleidomastoid which can cause cervicogenic vertigo."

 

 

 

 

Neurology

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By Brad McKechnie, DC, DACAN

Cervicogenic Vertigo

There is an increasing body of evidence indicating that not all cases of dizziness or vertigo of cervical origin are due to vertebrobasilar pathology. Receptors in the cervical spine apophysial joints and supporting musculature assume an important role in the maintenance of equilibrium. Afferent impulses originating from mechanoreceptors in the upper cervical spine project to the vestibular nuclei and to the reticular formation of the brain stem.^1-5 Injury to the cervical region may result in a disturbance of the afferent discharge from these receptors and precipitate vertiginous sensations and cervical nystagmus.

DeJong experimentally produced disorientation, imbalance, and in coordination in humans by anesthetizing the dorsal root afferent nerves in the upper cervical region with local anesthetics. These injections produced strong sensations of imbalance and of being pulled toward the side of the injected dorsal roots (impulsion). Test subjects experienced lightheadedness, an empty feeling in the pit of the stomach, a broad-based ataxic gait, and hypotonia of the ipsilateral arm and leg. Also noted in test subjects were a positive Romberg's test with falling or swaying to the side of the injected roots, past-pointing to the same side, and slight unsteadiness of gait after sudden head movements which lasted for several hours postinjection. These local anesthetic injections did not produce dysarthria, intention tremor, dysmetria, dysdiadochokinesia, or disturbances in kinesthesia.⁶

In another study, injection of local anesthetics into the dorsal roots of C1, C2,and C3 in monkeys induced severe alterations of balance, orientation, and motor coordination. Similar injections into the deep cervical musculature of produced nystagmus, severe alterations of balance, disturbed postural orientation, and motor in coordination.⁵

Patients experiencing cervicogenic vertigo may report the following clinical symptoms: positional unsteadiness or giddiness; a feeling that the ground is moving; postural instability noted especially on turning; and imbalance that is markedly enhanced by sudden head movements, such as neck extension with upward or downward gaze or rising from the supine position. Neck pain is always present in patients suffering from cervicogenic vertigo with muscle tenderness, stiffness, and guarding of the cervical region commonly noted. Neck pain may precede the sensations of imbalance by a period of days to months and is commonly located in the occipital region with radiations to the temporomandibular region, the temporal region, and into the arms. Headache complaints are common and occipital in origin with retro-orbital or band-like referred pain patterns. Occasionally patients may complain of numbness in the arms which is apparently without anatomical pattern.⁶

Patients often use the walls for assistance when walking, complain of bumping into objects while walking, and may appear to be hysteric. The imbalance experienced by the patient may be exacerbated by peripheral visual stimulation such as in walking down grocery store aisles, through shopping malls, or riding in cars. A high pitched tinnitus which may be associated with fluctuating hearing loss and a sensation of fullness in the ear is noted in 30 percent to 60 percent of cases and may suggest cochlear injury.⁶

Oculomotor testing may potentiate complaints of dizziness and during cervical range of motion testing the patient may fail to properly turn the neck. Afflicted patients may turn the entire neck and trunk as a unit in an effort to diminish the firing of cervical afferents which may potentiate dizziness. A useful clinical maneuver to ascertain the presence of cervicogenic vertigo involves placing the patient on a rotating stool, immobilizing the head, and then rotating the neck and trunk under the immobilized head. This maneuver may produce cervical nystagmus which may change direction based on the direction of neck and trunk rotation. It is postulated that this form of nystagmus is due to cervical afferent stimulation rather than from vertebrobasilar arterial insufficiency created by neck rotation. Cervical nystagmus created by neck rotation has an immediate onset whereas nystagmus noted in patients with vertebrobasilar arterial insufficiency is typically noted in susceptible individuals only after the head is rotated into the extremes of rotation and only after a latency period of several seconds to several minutes.⁷

Travell and Simons have demonstrated that trigger point activity in the upper fibers of the trapezius muscle and the clavicular division of the sternocleidomastoid muscle may create symptoms of momentary dizziness and spatial disorientation.⁸ Dizziness due to trigger point activity may be initiated by head movements. Thus, dysfunctioning proprioceptors in the cervical musculature or in the apophysial joints may lead to distortion of the normal input to the vestibular nuclei from the cervical region and lead to vertigo or dizziness of cervical origin.

References

1. Ciriani N et al. Retrograde axonal transport of fluorescent tracers from medullary reticular structures to the "neck" and "forelimb" segments of the cervical spinal cord. In: Berthoz A, Graf W, and Vidal P, The Head-Neck Sensory Motor System. Oxford University Press: New York, 1992.
2. Pompeiano O. Excitatory and inhibitory mechanisms involved in the dynamic control of posture during the cervicospinal reflexes. In: ibid.
3. Trippel M, Horstmann GA, and Dietz V. Significance of muscle proprioceptive and vestibulospinal reflexes in the control of human posture. In: ibid.
4. Wilson VJ. Physiological properties and central actions of neck muscle spindles. In: ibid.
5. Bogduk N. Cervical causes of headache and dizziness. In: Grieve GP. Modern Manual Therapy, Churchill-Livingstone: New York, 1986.
6. Brown JJ. Cervical contribution to balance: cervical vertigo. In: Berthoz A, Graf W, and Vidal P. The Head-Neck Sensory Motor System. Oxford University Press: New York, 1992.
7. Dvorak J and Dvorak V. Manual Medicine -- Diagnosis, 2nd ed. Thieme Medical Publishers: New York, 1990.
8. Travell JG and Simons DG. Myofascial Pain and Dysfunction -- The Trigger Point Manual. Williams and Wilkins: Baltimore, 1983.

Brad McKechnie, DC, DACAN
Pasadena, Texas

Vitamins that may be helpful

A preliminary trial showed that 15 mg per day of vinpocetine had a moderate or greater effect on reducing the signs and symptoms of vertigo in 77% of patients with this condition.²¹ Other preliminary reports exist describing benefits of vinpocetine for vertigo and other symptoms of inner ear disorders,²² but controlled research is needed to evaluate these claims.

Two preliminary human studies reported that vitamin B6 supplementation reduced symptoms of vertigo produced with drugs in a laboratory setting.²³ Vitamin B6 supplementation has not been studied in BPPV or other forms of vertigo and may not share the same causative mechanism as experimentally induced vertigo.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Herbs that may be helpful: In a preliminary clinical trial, a standardized extract of Ginkgo biloba (GBE) significantly reduced symptoms of vertigo in a group of elderly people with mild cognitive impairment.²⁴ Participants were given 40 mg three times per day for one year. GBE has also been reported to significantly reduce vertigo of unknown cause in preliminary²⁵ and double-blind²⁶ trials. The amounts given were 120 mg and 160 mg per day, respectively, for three months.

One gram of powdered ginger  (Zingiber officinale) root in a single application has been reported to significantly reduce symptoms of artificially induced vertigo in one double-blind trial.²⁷ In a double-blind trial, 1 gram of powdered ginger root was found to have very little effect in reducing vertigo related to seasickness.²⁸

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

Holistic approaches that may be helpful

Other integrative approaches that may be helpful: Numerous preliminary reports suggest certain “vestibular rehabilitation�?exercises may help some cases of vertigo.^{29 30 31 32 33 34} These exercises were also found to be effective in relieving vertigo in two controlled studies,³⁵ including one on BPPV.³⁶ While vestibular rehabilitation exercises may be done at home, initial guidance by a qualified practitioner is necessary.

BPPV appears to be caused by an accumulation of free-floating cell fragments in the fluid of the inner ear.^{37 38} Certain manipulation therapy maneuvers, referred to as particle repositioning maneuvers (PRMs), are intended to relocate this debris to a harmless location,^{39 40 41} in order to improve symptoms. Both preliminary^{42 43 44 45 46} and controlled^{47 48 49} trials achieved significant improvement in, or elimination of, BPPV using these maneuvers. Most studies report that over 90% of people with BPPV treated one or two times with PRM respond to this treatment, although up to 45% may develop BPPV again within a few years, requiring further treatments.^{50 51 52}

Research indicates some cases of vertigo are related to spinal disorders affecting the head and neck.^{53 54 55 56 57 58 59} Preliminary studies report that certain treatments, such as spinal manipulation,^{60 61 62 63} physical therapy,⁶⁴ and combined approaches including manipulation and specific exercise programs,^{65 66} result in significant improvement of vertigo symptoms.

Trigger points are thought by most,^{67 68 69} though not all,⁷⁰ authorities to potentially cause pain and abnormal function in other parts of the body. Trigger points appear to develop as the result of injury, poor posture, structural abnormalities of the leg or pelvis, emotional tension, and other body stressors.^{71 72} Also known as myofascial pain dysfunction (MPD), this condition, when it affects certain muscles of the head and neck, has been associated with vertigo in preliminary research.^{73 74 75} Musculoskeletal healthcare specialists and other practitioners can often treat MPD with a variety of natural therapies, including deep pressure massage,^{76 77 78 79 80} transcutaneous electrical nerve stimulation (TENS),^{81 82} and other approaches,⁸³ but no controlled studies have investigated the effectiveness of these treatments specifically for vertigo.

In a preliminary study of people with migraine headaches, most of whom (83%) also experienced vertigo, a combined and individualized approach using dietary changes, medication, physical therapy, lifestyle changes, and acupuncture resulted in complete or substantial improvement of symptoms in a significant number of participants.⁸⁴ In addition, a large number of case studies presented in two preliminary reports suggest acupuncture may help to reduce symptoms of vertigo.^{85 86} These preliminary studies have yet to be confirmed by controlled clinical trials.

Thanx so much for the information - there was so much there  -- I'm going to my family doctor on Tues. and will talk to him about what I've figured out and try to get some help with it.. Today has been pretty good as I haven't moved much off the couch or typed much at all - so I'm off again for now.. I do know it's movement that is triggering my neck and that is causing the dizziness but I don't have to move much to have it gone on me..

 

Thanx again!

 

Sharon