The Bárány Society position on 'Cervical Dizziness'
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Author(s)
Type
Journal Article
Abstract
This paper describes the Bárány Society Classification OverSight Committee (COSC) position on Cervical Dizziness, sometimes referred to as Cervical Vertigo. This involved an initial review by a group of experts across a broad range of fields, and then subsequent review by the Bárány Society COSC. Based upon the so far published literature, the Bárány Society COSC takes the view that the evidence supporting a mechanistic link between an illusory sensation of self-motion (i.e. vertigo – spinning or otherwise) and neck pathology and/or symptoms of neck pain - either by affecting the cervical vertebrae, soft tissue structures or cervical nerve roots - is lacking. When a combined head and neck movement triggers an illusory sensation of spinning, there is either an underlying common vestibular condition such as migraine or BPPV or less commonly a central vestibular condition including, when acute in onset, dangerous conditions (e.g. a dissection of the vertebral artery with posterior circulation stroke and, exceedingly rarely, a vertebral artery compression syndrome). The Committee notes, that migraine, including vestibular migraine, is by far, the commonest cause for the combination of neck pain and vestibular symptoms. The committee also notes that since head movement aggravates symptoms in almost any vestibular condition, the common finding of increased neck muscle tension in vestibular patients, may be linked as both cause and effect, to reduced head movements. Additionally, there are theoretical mechanisms, which have not been explored, whereby cervical pain may promote vaso-vagal, cardio-inhibitory reflexes and hence by presyncopal mechanisms, elicit transient disorientation and/or imbalance. The committee accepts that further research is required to answer the question as to whether those rare cases in which neck muscle spasm is associated with a vague sense of spatial disorientation and/or imbalance, is indeed linked to impaired neck proprioception. Future studies should ideally be placebo controlled and double-blinded where possible, with strict inclusion and exclusion criteria that aim for high specificity at the cost of sensitivity. To facilitate further studies in “cervical dizziness/vertigo”, we provide a narrative view of the important confounds investigators should consider when designing controlled mechanistic and therapeutic studies. Hence, currently, the Bárány COSC refrains from proposing any preliminary diagnostic criteria for clinical use outside a research study. This position may change as new research evidence is provided.
Date Issued
2022-01-01
Date Acceptance
2022-12-01
Citation
Journal of Vestibular Research: Equilibrium and Orientation: an international journal of experimental and clinical vestibular science, 2022, 32 (6), pp.487-499
ISSN
0957-4271
Publisher
IOS Press
Start Page
487
End Page
499
Journal / Book Title
Journal of Vestibular Research: Equilibrium and Orientation: an international journal of experimental and clinical vestibular science
Volume
32
Issue
6
Copyright Statement
© 2022 – The authors. Published by IOS Press. This is an Open Access article distributed under the terms
of the Creative Commons Attribution-NonCommercial License (CC BY-NC 4.0).
of the Creative Commons Attribution-NonCommercial License (CC BY-NC 4.0).
License URL
Identifier
https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000903588300001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
CEREBRAL BLOOD-FLOW
Cervical
cervicogenic
CERVICOGENIC DIZZINESS
CERVICOOCULAR REFLEX
dizziness
DOUBLE-BLIND
HEAD MOTION
Life Sciences & Biomedicine
MANUAL THERAPY
MULTIMODAL INTEGRATION
NATURAL APOPHYSEAL GLIDES
neck
NECK PAIN
Neurosciences
Neurosciences & Neurology
Otorhinolaryngology
Science & Technology
vertigo
vestibular
VESTIBULAR NUCLEI
Publication Status
Published
Date Publish Online
2022-12-18