The Mystery Behind Vertigo and Dizziness

November 28, 2017

Hi everyone!  Welcome to the second week of the Straight & Narrow.  We have decided to include the “Bottom Line” before each post which highlights the pertinent details of each post.  Not only do you get information in a blink of an eye, but you can have extra detail too!


Bottom Line:


  • There are two main causes of vertigo and dizziness: benign paroxysmal positional vertigo and Cervicogenic vertigo

  • Cervicogenic vertigo is caused by multiple things including: neck muscle strain, joint capsule irritation, injury to the nerves, joint degeneration

  • Studies have shown significant improvement of cervicogenic vertigo with physiotherapy and chiropractic treatment

  • Benign paroxysmal positional vertigo is caused by dysfunction of the vestibular system of the inner ear

  • Benign paroxysmal positional vertigo can be treated effectively with the Epley maneuver


Dizziness and Vertigo


Feeling dizzy, unbalanced, or like the world is spinning around you? If you answered yes to any of these questions, you are not alone! Vertigo and dizziness are among the 20 most common causes of consultation in adult patients, affecting 50% of the population over 65 and is the most frequent reason for medical consultation after the age of 75.  If this dizzy feeling is something you have experienced before or have had for a long time I am sure that you have heard the term vertigo.  Today we will be discussing two main causes of vertigo and dizziness: Benign Paroxysmal Positional Vertigo and Cervicogenic Vertigo.


Cervicogenic Vertigo


Cervicogenic vertigo occurs with persistent loss of balance due to dysfunction of the cervical spine.  Cervicogenic vertigo is a debated disorder without a universally agreed upon cause.  However, the prevailing theory is that it is caused by impaired function of the


deep muscles of the neck and highly-clustered innervation of the upper cervical spine.  This impairment causes decreased proprioception and a diminished ability to balance.  There has also been a strongly established link between cervical spondylosis (narrowing of the canals due to degeneration).  Cervicogenic vertigo is also very prevalent in whiplash injuries due to damage of cervical joint capsules, ligaments and musculature.  Despite the contestable nature of cervicogenic vertigo, it is a real disorder with significant effects. 


But behold!  There is treatment for cervicogenic vertigo.  Recent research has shown that manual therapy, mobilizations, manipulations to the neck result in significant relief from dizziness.  Both physiotherapy and chiropractic treatments have been shown to have marked improvement in balance.                    


Benign Paroxysmal Positional Vertigo


Benign Paroxysmal Positional Vertigo or BPPV is a benign disorder of the inner ear classified by repeated episodes of a spinning sensation often triggered by changes in head position.  BPPV most often occurs in both men and women between the ages of 50-60 years old and affects women 2-3 times more often than men.  


Normally, sensory hair cells in inner ear structures detect fluid (endolymph) movements during motion of the head or body, signalling brain for sensation of motion or position.  With BPPV, small crystals of calcium carbonate from the macula densa and utricles of the inner ear can enter the semicircular canals. This build-up of small crystals in the canals leads to a false sense of rotation as if the static position of the head is changed resulting in a spinning dizzy sensation referred to as vertigo and associated nystagmus, nausea and even vomiting.  However, vestibular dysfunction can also be caused by anticonvulsants, antidepressants, antihypertensive, neuroleptics, and sedatives.


BPPV can be treated with the help of a trained practitioner through a procedure known as the Epley maneuver. The Epley maneuver helps realign the crystals in the inner ear and reset the vestibular system.  It has short term efficacy and patients can treat themselves at home with modified Epley procedure.  We strongly suggest that the Epley maneuver be performed by a trained practitioner.    Below is an example of the Epley maneuver:


We hope you enjoyed the read!  Tune in in two weeks for our next article: Intermittent Fasting - Is Breakfast REALLY the Most Important Meal of the Day???






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