A combined approach for the treatment of cervical vertigo☆

Background: Cervical vertigo is a diagnosis commonly made at both otorhmolanngologast and chimpraetie offices. Hypothesized non-vascular mechanisms are reviewed. Therapeutic approaches have been suggested in the literature, ranging from cervical immobilization to vertebral manipulation. Objective: To characterize the patient population with cervical vertigo and observe therapeutic results of a treatment protocol by using distinct conservative modalities. Methods: Fifteen subjects with cervical vertigo were selected from patients presenting with dizziness at an otorhinolaringology medical office. Diagnosis was based on specific criteria and results of an otoneurologic examination. All patients were submitted to a treatment protocol, including spinal manipulation, manual therapy on affected muscle groups, analgesic electrotherapy, labyrinth sedation, surface electromyography biofeedback, and an exercise program. Evolution of dizziness complaints and related musculoskeletal dysfunction was observed. Results: Musculoskeletal complaints were present in 93% of the patients, mainly cervical pain, shoulder-girdle pain, and tension-type headache. Median duration of musculoskeletal symptoms was 7.5 years, whereas the median duration of dizziness before the boginning of treatment was 52 days. Treatmeat duration averaged 5 sessions and 41 days. At the end of treatment, 60% of patients reported remission, and 20% reported consistent improvemant of vertigo. Remission of musculoskeletal symptoms was observed in 26.7% of patients, and improvement was observed in 60% of patients. Conclusion: Chronic, nontraumatic, cervical and shoulder-girdle dysfunction was an important causal and perpetuating factor of cervical vertigo in the population studied, and a consistent improvement was observed with the use of a conservative treatment protocol involving multiple modalities for patients with cervical vertigo. Further controlled studies are needed to access its validity. (J Manipulative Physiol Ther 2000;23:96–100)