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Cervical Vertigo
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Cervical Vertigo

I have transient head, cranial and neck pain and concomitant vertigo. I just had a MRA that covered the circle of willis(no contrast) and a MRA of cervical neck. I've had this problem for 5 months it is less intense as it was but still have balance issues and the sense that I could go into a spin.

Am I on the right track with this or do I need to ask for some other kind of test with my neuro doctor?

My fear is that nothing will show and he will dismiss it back to menieres.

What treatments are available if it is some kind of vetebral artery? is there a way to open up the blockage?

what treatment is there for CSF blockage(I feel a lot of pressure in my head at times)
Avatar_dr_m_tn
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Causes of neck pain associated with headache are cervicogenic headache and occipital neuralgia.

Cervicogenic headache is a headache that is "referred" to the head from bony structures, muscles, and other soft tissue in the neck and shoulders. Symptoms are usually one-sided and include: precipitation of head pain by neck movement or awkward neck positions, head pain when external pressure is applied to the neck or occipital region, restricted range of motion of the neck, and neck, shoulder and arm pain. Treatment for cervicogenic headache includes physical therapy, medications, behavioral therapy, and other modalities.

Occipital neuralgia is caused by irritation or injury to two nerves that run from the upper neck to the back of the head. The irritation could be due to  neck trauma, pinching of the nerves (by muscles or arthritis), and other causes. Symptoms include a piercing sharp pain that travels from the upper neck to the back of the head and behind the ears. It is usually a one sided pain but can be on both sides of the head. Treatment includes physical therapy, medications, and in some cases injections, "nerve blocks", during which a physician injects the irritated nerves with an anesthetic.

Patients with dizziness due to neck pathology (cervicogenic dizziness) often complain of dizziness that is worse with particular head movements and when the head is maintained in one specific posture for prolonged periods. Neck pain and a headache in the occipital region (the back of the head above the neck) may be associated with the dizziness. The dizziness may last minutes to hours after assuming certain head positions.

A concerning cause of neck pain associated with headache is a dissection: a small tear in the blood vessels that travel up the neck to the brain. This can occur spontaneously in people with certain conditions that affect the blood vessels, after neck trauma, or after chiropractic manipulation of the neck. The pain is often but not always associated with some sort of neurologic deficit as a dissection can often lead to a stroke. A dissection is diagnosed with a specific type of MRI test (MRA with fat saturation) or an CT angiogram. It sounds like you had an MRA that was unremarkable. (These will include vertebral arteries).

Also, if by dizziness you mean vertigo (room-spinning), the causes could be either the inner ear or the brain. Inner ear causes of vertigo most commonly include benign positional vertigo (BPPV), which is due to small particle in the inner ear that moves out of place, and can be repositioned with simple head maneuvers. The symptoms often include vertigo that occurs with turning of the head, often while turning over in bed. Another cause, if your symptoms are associated with tinnitus (ear ringing) and hearing loss is called Meniere’s disease and can be treated with medications and sometimes surgery. And so on, several other causes from inner ear problems exist.

Vertigo can also be due to problems in the brain. The most common is a benign tumor called a schwanoma (also called acoustic neuroma). This is diagnosed by MRI of the brain. Multiple sclerosis can cause vertigo, but often, other symptoms are present as well. A normal MRI of the brain excludes multiple sclerosis. Did you have contrast you’re your MRI? Thyroid problems can also lead to vertigo.

Your symptoms may be consistent with a variant of migraine called basilar migraine. Basically this is marked by several hours of vertigo associated with nausea, light-sensitivity, and sometimes other symptoms. Headache may or may not be present. The treatment is different from that used to treat other migraine types; the treatment in this case is a type of medication called calcium channel blocker, such as verapamil, which is actually used to treat blood pressure but works in type of basilar migraine as well.

If by dizziness you mean light-headedness, causes could include low blood pressure such as due to dehydration or autonomic dysfunction, cardiac problems, and several other non-neurologic causes. Anemia can cause light-headedness as well.

As you can see, the differential is broad. Having a normal MRI and MRA does exclude several possibilities. I suggest that you follow up with a neurologist to evaluate further. Treating the headaches may improve the vertigo. Also, you may need physical therapy with an emphasis on vestibular therapy.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

2 Comments
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I have transient head, cranial and neck pain and concomitant vertigo. I just had a MRA that covered the circle of willis(no contrast) and a MRI of cervical neck. I've had this problem for 5 months it is less intense as it was but still have balance issues and the sense that I could go into a spin.

Am I on the right track with this or do I need to ask for some other kind of test with my neuro doctor?

My fear is that nothing will show and he will dismiss it back to menieres.

What treatments are available if it is some kind of vetebral artery? is there a way to open up the blockage?

what treatment is there for CSF blockage(I feel a lot of pressure in my head at times)
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