Treatment of Cervically Mediated Dizziness

Cervicogenic dizziness can be successfully treated with a combination of neck physiotherapy, occipital nerve blocks, and oral antineuritic pain medications such as gabapentin or amitriptyline. Thus, nonsurgical treatment for both cervicogenic headache and dizziness overlap.

Further understanding of cervicogenic dizziness comes from treating dizzy patients without headache and cervicogenic headache patients without dizziness. The disorder is suggested by not meeting IHS criteria for either cervicogenic headache or migraine. A spectrum of improvement was seen with greater occipital nerve injections for patients with dizziness and headache, including relief of symptoms of ear discomfort, tinnitus, and neck pain, along with improvements in the headache and dizziness.

The upper cervical spine may play an important role in various headache and vestibular disorders, and an underlying mechanism may connect the trigeminal nucleus caudalis and trigeminocervical pathways. Due to the intricate pathophysiol-ogy of headache and dizziness separately, it is plausible to also conceptualize situations in which a vestibular syndrome (peripheral or central) can provoke a headache syndrome and vice versa.

Certain common factors can provoke both headache and dizziness, suggesting this potential anatomic relationship. These include trauma, congenital abnormalities, comorbid illnesses, infections, and medications, and are listed in Table 20.10.

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