Transient dizziness or vertigo that occurs with head movements is often attributed to a vestibular problem like BPPV ([ Ссылка ]). However, cervical spine problems that have nothing to do with the inner ear can also elicit vertigo attacks with head movements. Additional symptoms that suggest a cervicogenic source of dizziness instead of the inner ear include history of headache, neck pain, and limited cervical range of motion.
There are bedside tests which can further suggest the diagnosis of cervicogenic vertigo, especially if the Dix-Hallpike test ([ Ссылка ]) for BPPV comes back normal. These tests require the head to be kept still to prevent any activation of the inner ear balance system. As such, any test movements that trigger dizziness is thus isolated to the cervical spine as the source of the vertigo.
The head neck differentiation test is performed with the patient seated on a swivel chair with the hip and knees flexed to 90 degrees. The patient closes both eyes and the examiner fixates the patient's head in neutral position as shown. The patient is then asked to actively rotate the body 45 degrees with the help of the legs to the left and then right side in an alternating fashion at a metronome pace of 60 beats per minute for at least 30 seconds.
The test is positive if the patient reports any dizziness and/or any other symptoms other than normal. Other symptoms include visual disturbances, speech disturbances, motion sickness, nausea, trouble swallowing, lightheadedness, tinnitus, headache and/or paresthesias during or immediately after the test.
If cervicogenic vertigo is suspected, please see your healthcare professional for further treatment guidance. A neurologist or a spine specialist are the doctors who specialize in treating this condition. There are also home exercises that can be performed to treat cervicogenic vertigo, but should only be performed if there is no pain and no numbness present.
Please be aware that this test has a specificity of 90%. Sensitivity has not been determined yet which makes the clinical use of this test unknown at this time.
Other tests for cervicogenic vertigo:
• Cervical Torsion Test: [ Ссылка ]
• Smooth Pursuit Neck Torsion Test: [ Ссылка ]
Home exercises for cervcigeic vertigo: [ Ссылка ]
• Intro (0:00)
• Head Neck Differentiation Test (0:50)
• Conclusion (1:44)
References:
Normative responses to clinical tests for cervicogenic dizziness: Clinical cervical torsion test and head-neck differentiation test. Physical Therapy, 100(1), 192-200. 2020. [ Ссылка ]
Video created by Dr. Christopher Chang:
[ Ссылка ]
Actor Credit:
MJ Gordon @marinjayden
Certified Yoga Alliance Instructor (RYP500, RPYT, Yin)
Certified Fitness Instructor NCEP
[ Ссылка ]
Still haven’t subscribed to Fauquier ENT on YouTube? ►► [ Ссылка ]
