How common is Cervicogenic Dizziness?

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When considering dizziness of cervical origin, it is well accepted in clinical practice to follow the rule of “diagnosis of exclusion”.  This means that you can suspect, but not confirm, dizziness or vertigo from the neck unless you rule out other competing diagnoses.

It is thrown around from ones who try to invalidate the condition that up to 90% of cases can have a convincing alternative diagnosis.  Additionally, Cervicogenic Dizziness can affect populations across the lifespan with traumatic and even non-traumatic origin. Therefore, the prevalence of Cervicogenic Dizziness can be challenging to truly calculate.

However, we can reach out to the literature to provide some input on how frequent patients have Cervicogenic Dizziness.  We provide a synopsis for you below to help with prevalence rates for these subcategories.

Elderly / Geriatrics

A classic study cited in most often comes from Colledge et al in 1996 in BMJ.  This is a community based study looking at causes of dizziness in elderly patients in primary care practice.  The investigators found that 30% of total patients had dizziness symptoms and contributed 66% of those cases to cervical spondylosis (arthritis).  Two-thirds of the patients with dizziness coming from the neck is a significant proportion!

A more recent study by Sho Takahashi in 2018 retrospectively examined the cause of general dizziness in an outpatient setting.  Out of the 1000 patients, 899 (90%) were found to have cervicogenic general dizziness.  The authors contribute cervical spinal canal stenosis as the culprit in the group with average age of 62 years old.  Wow, 9 out of 10 patients were found to have dizziness coming from the neck!

So yes, the geriatric population, even though with higher proportion of competing diagnoses including peripheral, cardiovascular, and psychological causes; have a high prevalence of Cervicogenic Dizziness.  For therapists out there who are in vestibular rehab / neuro rehab and even home health, this is something to consider!

We can’t forget the data from the concussion and whiplash literature.  Here are some other robust numbers for you:

Whiplash

The literature on this is somewhat older but still very pertinent, stands true to today, and actually we have more data from multiple sources.  I always say about half of patients who have had whiplash-associated disorder experience dizziness and/or imbalance. To name a few, I recommend reading the works of Diane Wrisley 2000, Oostesteveld et al 1991, Skovron 1998, Humphreys & Peterson 2013. 

Non-Traumatic Cervicogenic Dizziness

For those who are not treating the elderly and not dealing with trauma, the numbers are not nearly as hefty.  I always mention to my students that the prevalence in this realm is ~10%.  Even though the patient age and criteria within these studies vary, I lump this under non-traumatic Cervicogenic Dizziness. This is where I get my data:

Ardic et al 2006, in a retrospective chart review, noted dizziness of cervical origin at 7.5%.

Luscher et al 2014, in a prospective, observational, multi-center study, noted dizziness of cervical origin at 6.4%.

Reid et al 2015, in a randomized-controlled trial, had 8.5% of participants fulfill the inclusion and exclusion criteria as having Cervicogenic Dizziness.

From the outside looking in, the literature is all over the place with our prevalence numbers!  This is what makes the condition challenging and exciting to treat and help others.  You can consider Cervicogenic Dizziness as a single entity, double entity and even traumatic vs non-traumatic origin. Therefore, the prevalence of Cervicogenic Dizziness can be challenging to truly calculate.  I hope this information helps you make a better decision in the office.

You can learn more about the screening and treatment process of Cervicogenic Dizzinesss through Integrative Clinical Concepts, where the authors (husband–a manual therapist a wife—a vestibular specialist), teach a very unique course combining both the theory and practice of vestibular and manual principles in their 2-day course.  Pertinent to this blog post, the 1st day includes the “Optimal Sequence Algorithm”, a multi-faceted physiotherapist approach to the assessment of Cervicogenic Dizziness, which includes the appropriate ruling-out process and cervical examination of the articular and non-articular systems. Also pertinent to this blog post, the 2nd day includes the “Physio Blend”, a multi-faceted physiotherapist approach to the management of Cervicogenic Dizziness, which includes treatments of the articular and non-articular system of manual therapy and the most updated sensorimotor exercise regimen.

If you would like to host a course for your staff (either a vestibular, neuro, sports or ortho clinic), please do not hesitate to contact me at [email protected] for more information.

Authors

Harrison N. Vaughan, PT, DPT, OCS, Dip. Osteopracic, FAAOMPT    

Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts

Danielle N. Vaughan, PT, DPT, Vestibular Specialist  

Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts

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