Have you ever felt the room spinning around you?
Or felt like you just walked off a boat that had been in a rough ocean, almost like you can’t balance on your own two legs?
Has it ever been so bad that it makes you nauseous or “seasick”?
Those sensations and feelings are known as vertigo.
What is Vertigo?
Vertigo is an umbrella term for feeling like things are spinning around you, feeling unbalanced, or lightheaded.
In more severe cases, nausea and vomiting can be associated.
There are two main types of vertigo: central vertigo and peripheral vertigo.
There is also a secondary type of vertigo called cervicogenic vertigo that often has to do with mechanical disruption or disruption of joint motion in the cervical spine.
So, can chiropractic help with vertigo?
Peripheral Vertigo
Peripheral vertigo is caused by an inner ear issue.
The inner ear controls your balance.
Within the inner ear, there is an area called the vestibular labyrinth, also known as the semicircular canals.
This system of canals consists of an anterior, horizontal, and posterior canal.
These canals respond to the head and neck’s angular movement (rotating motion) voluntarily or by an accelerated force.
Within the inner ear, there are also small calcium crystal-like formations called otoliths.
The otolith’s job is to sense gravity and linear acceleration or motion.
If the structures in the inner ear are not working properly or are disrupted due to an injury or illness, it can easily cause dizziness, lightheadedness, or feeling unbalanced.
To determine which canal is inhibited, the patient will be asked to perform various head motions.
Evaluating the Inner Ear
The patient is asked to nod their head back and forth, saying “yes.”
If dizziness or vertigo-like symptoms are recreated, it can be determined that the issue might be coming from the anterior canal.
The patient is asked to tip their head from side to side (ear to shoulder).
If dizziness or vertigo-like symptoms are recreated, it can be determined that the issue might be coming from the posterior canal.
The patient is asked to shake their head back and forth as if they are saying “no.”
If dizziness or vertigo-like symptoms are recreated, it can be determined that the issue might be coming from the horizontal canal.
The posterior and anterior canals are more likely to be affected than the horizontal canal, which often has a 1-2% chance of being the primary issue.
The Different Types of Peripheral Vertigo
Next, let’s look at the different types of peripheral vertigo.
Benign paroxysmal positional vertigo (BPPV)
BPPV is best characterized by brief mild to severe episodes of dizziness or feeling like you are spinning or the room is spinning.
These episodes are often triggered by head movement or position.
Did You Know
This is one of the most common types of vertigo.
Labyrinthitis
This type of vertigo is often caused by an infection in the inner ear or labyrinth of the ear, where balance and hearing are controlled.
Common symptoms include feeling like you are moving when you are not and dizziness often accompanied by a headache, fever, or earache due to an infection.
The flu, the common cold, or bacterial infection usually causes this type of vertigo.
Vestibular Neuronitis
This type of vertigo is caused by an infection that has spread to the vestibular nerve affecting the patient’s balance.
This type of vertigo almost always follows the flu or cold infection.
It is characterized by a sudden onset of symptoms that could cause an earache, unsteadiness, nausea, or vomiting.
Meniere’s Disease
This is a sudden bout of vertigo that is very severe, causing nausea and vomiting, and can last up to 24 hrs.
It is also characterized by hearing loss, ringing in the ears, and a feeling of fullness in the ears.
The exact cause of Meniere’s Disease is unknown, but it seems to be due to an abnormal amount of fluid (endolymph) in the inner ear.
Improper drainage of fluid due to a blockage or anatomical blockage, abnormal immune response, viral infection, or a genetic predisposition are all things that could affect the amount of fluid in the inner ear.
Central Vertigo
Central vertigo is often caused by an issue or problem within the brain or brainstem.
The Different Types of Central Vertigo
These types of vertigo are often more concerning and severe.
Conditions That Often Cause Central Vertigo
- Blood vessel disease
- Certain drugs, such as anticonvulsants, aspirin, and alcohol
- Multiple sclerosis
- Seizures (rarely)
- Stroke
- Tumors (cancerous or noncancerous)
- Vestibular migraine, a type of migraine headache
Symptoms associated with central vertigo can include loss of consciousness, numbness, weakness, diplopia (double vision), dysarthria (trouble speaking), ataxia, loss of the visual field, difficulty swallowing, tinnitus, severe headache, or drooping of the eyelid.
Cervicogenic Vertigo
Cervicogenic vertigo is a clinical syndrome that is often characterized by imbalance, dizziness, neck pain, limited range of motion, and at times accompanied by a headache.
The symptoms associated specifically with this type may have you quickly wondering “can chiropractic help with vertigo?”
To be considered cervicogenic vertigo, the cervical spine is considered the cause of dizziness when all other causes are ruled out.
The dizziness the patient feels is often closely related to cervical spine position and joint motion.
It is unknown what specifically causes the symptoms of feeling off-balance, dizziness, disorientation, or unsteadiness.
It’s been suggested that faulty cervical proprioceptive inputs could be a factor or that there is a disruption of afferent signals (signals going toward the brain) from the upper cervical spine causing the brain not to be able to orient where in space the head is.
Can Chiropractic Help with Vertigo? Yes!
Chiropractic care is often sought out for vertigo.
There are several things that a chiropractor can do to help a patient suffering from peripheral vertigo.
First, chiropractors have significant and specific training in diagnosing cervicogenic dizziness or vertigo from peripheral or central vertigo.
During medical training to become a chiropractor, they are taught how to assess cranial nerves for proper function, how to assess the cervical spine for proper joint motion, and how to determine if the bouts of vertigo are coming from a peripheral source, central source (brain or brainstem), or a mechanical source (cervicogenic vertigo).
How Chiropractors Assess Vertigo?
- A comprehensive history of the patient vertigo symptoms
- A full look at the spinal range of motion and movement
- Testing specific head motions such as rotation, lateral flexion, flexion, and extension to see if symptoms can be reproduced
- Testing cranial nerves
- Looking at how your eye moves with specific motions
- Specific orthopedic tests that help determine the cause of your vertigo (swivel chair test, Dix-Hallpike, vertebral artery test, cervical position sense, romberg test, roll test, nystagmus, finger-pointing test, and Babinski-Weil, saccadic eye motion test, smooth pursuit test, gaze coordination, cranial nerve test, and eye-head coordination test)
When determining the difference between cervicogenic vertigo and peripheral vertigo, your chiropractor will start with several exams.
During a physical exam, your chiropractor will see if specific head movements recreate your symptoms.
Often if symptoms are recreated with head movement and then are lessened with stabilization of head movement, it can be determined that the cause of vertigo could be BPPV, a type of peripheral vertigo.
If symptoms do not occur with head movement or if vertigo and nystagmus continue, it suggests that the vertigo is a central pathology such as the types listed in the central vertigo section.
During the physical exam, your chiropractor should also look for symptoms that do not indicate that BPPV is the origin of your vertigo.
How Chiropractors Rule Out Vertigo?
- Head injury or trauma
- Vertebrobasilar insufficiency (VBI) (5 Ds: dizziness, diplopia, drop attacks (loss of power or consciousness), dysphagia (problems swallowing), dysarthria (problems speaking), 3 Ns: nystagmus, nausea or vomiting, other neurological symptoms, 5 others: light headiness or fainting, disorientation or anxiety, disturbances in the ears – tinnitus, pallor, tremors, sweating, fascial paraesthesia or anesthesia)
- Loss of consciousness
- Frequent unexplained history of falls
- Hearing loss
- Earache, ear infection, fullness in the ear
- Ataxia
- Changes to or loss of your visual field
- Difficulty speaking
- Difficulty swallowing
- Facial or extremity paralysis
These are all symptoms that suggest a more severe pathological or central cause of vertigo and should be addressed as soon as possible with you and your healthcare provider.
These symptoms may also spark concern, and you could be referred to a neurological specialist if needed.
Can Chiropractic Help With Vertigo? Neurological Referrals
A specific test for helping to determine if BPPV is present is called the Dix-Hallpike test.
It is considered the gold standard for deciding posterior semicircular canal involvement.
If this test is positive, then it can be determined that BPPV is present.
If BPPV is determined to be present, canalith repositioning maneuvers and at-home exercises are the standard treatment.
At times an adjustment of the cervical spine can also help the patient’s symptoms decrease.
If a high velocity, low amplitude adjustment (HVLA) is not tolerated by the patient, instrument-assisted chiropractic adjustive techniques (IACMT) can be utilized with a tool called an activator.
If cervicogenic vertigo is determined to cause the patient’s vertigo, chiropractic care is the standard of treatment.
Manual adjusting, IACMT, manual massage, and exercises to improve the patient’s active range of motion can be very helpful in decreasing the symptoms.
Patients should consult their chiropractors for patient-specific treatment plans.
There are many different types of vertigo and many other things that can cause vertigo.
Pro Tip?
Your local chiropractor is your best resource to helping you figure out what is causing your symptoms and what treatment can help decrease your symptoms.
They are also able to refer you out to other medical specialties if needed.
So, if you suffer from vertigo or vertigo-like symptoms, there is treatment, and your chiropractor can help you get the treatment and help you need.
Click to View Science Sources
- The Semicircular Canals. Neuroscience. 2nd edition. Sunderland (MA): Sinauer Associates. 2001.
- Vertigo-Associated Disorders. Medline Plus. 2021.
- Benign Paroxysmal Positional Vertigo (BPPV). Mayo Clinic. 2020.
- Meniere’s Disease. Mayo Clinic. 2020.
- Peripheral Vertigo. Healthline. 2018.
- How to Diagnose Cervicogenic Dizziness. Archives of physiotherapy vol. 7 12. 2017.
- Essential Skills for Managing Benign Paroxysmal Positional Vertigo. American Chiropractic Association. 2018.
- Central Vertigo. StatPearls Publishing. 2021.
- Cervicogenic Dizziness: Screening. Physiopedia. 2021.
