Otoneurology (i.e. a neurologist that specializes in dizziness and hearing disorders) is the specialty that seems most reasonable for cervical vertigo - -but there are very few otoneurologists in the world. Practically, the safest thing to do to us seems to be to locate a sympathetic and thoughtful physician to be the "captain of the ship", see appropriate specialists to exclude alternatives involving the ear (e.g. BPPV) , and brain (e.g. migraine), and take reasonable measures to decrease neck pain and stiffness (e.g. physical therapy, and pain clinic if this fails).
On the other hand, a recent large Canadian study reported that the risk of vertebral artery territory stroke was greater for both visits to chiropractors and primary care physicians (Cassidy et al, 2008). The authors of this study inferred in their discussion that this observation meant that visits to chiropractors does not cause strokes, as the same risk of stroke was seen in situations where there was no manipulation of the neck. However, we are not so sure as we think there is a logical fallacy. Another way to interpret this data is that vertebral artery strokes are generally diagnosed by seeing primary care physicians, sometimes later rather than sooner, and that this comparison is simply invalid as a visit to a physician is required for diagnosis of a stroke anyway. A more proper comparison would be with visits to, lets say, a dermatologist and chiropractic visits.
11 Easy Home Remedies for the Treatment of Vertigo
Chiropractors often seem unaware that visits to a chiropractor are associated with stroke (Haldeman et al, 2002). We usually recommend against chiropractic treatment of vertigo that includes "snapping" or forceful manipulation of the cervical vertebrae.
NHS Direct Wales - Encyclopaedia : Vertigo
With respect to history, the key observation is that dizziness is triggered by lying down, or on rolling over in bed. Most other conditions that have positional dizziness get worse on standing rather than lying down (e.g. ). There are some conditions that have symptoms that resemble BPPV. Patients with certain types of central vertigo caused by cerebellar injuries can have similar symptoms. Patients with can also sometimes show eye movements resembling bilateral BPPV.
Vertigo causes & treatment - Illnesses & conditions | …
Electronystagmography () testing may be needed to look for the (jumping of the eyes) induced by the Dix-Hallpike test (also see here). For diagnosis of BPPV with laboratory tests, it is important to have the ENG test done by a laboratory that can measure vertical eye movements. A magnetic resonance imaging () scan will be performed if a stroke or brain tumor is suspected. A may be used for difficult diagnostic problems. It is possible but uncommon (5%) to have BPPV in both ears (bilateral BPPV).
BPPV -- Benign Paroxysmal Positional Vertigo
Koskimies et al (1997) reported that individuals with "tension neck", had greater postural deviations induced by vibration of their neck than persons without a stiff neck. They suggested that this association might contribute to vertigo. In other words, a tight neck might increase input from muscle proprioceptors, and dizziness due to too much proprioception. Magnussen et al (2006) similarly reported that when the neck is activated, cervical input is switched to become dominant over vestibular input. One could hypothesize that in cervical vertigo could occur when neck input became dominant over vestibular, due to neck pain or stiffness.
Vertigo (Hitchcock, 1958) | Narrative Journey
Dissection means that the wall of an artery is torn, and blood enters between two layers of the artery, often causing it to block. With respect to dissection, it is thought that vertebral arteries can be damaged at the points that they are anchored in the upper cervical spine, through a mechanism that involves stretching. Generally speaking, this occurs due to a traumatic event such as a motorcycle accident. Dissection is reportedly more common in individuals who are "double jointed", such as the Ehlers-Danlos syndrome.