Cervicogenic Dizziness: What Chiropractors Need to Know About the Neck-Balance Connection

Many of your patients with neck pain also report dizziness, unsteadiness, or a feeling of being “off.” Sometimes these symptoms are coincidental. Sometimes the neck is actually driving them. A new perspective paper in Frontiers in Neurology (2025) takes a deep look at cervicogenic dizziness – what it is, why it’s so hard to diagnose, and what the evidence says about treating it – and it’s essential reading for any chiropractor managing cervical spine patients.

What Is Cervicogenic Dizziness?

Cervicogenic dizziness (CGD) is defined as non-rotary dizziness – think lightheadedness, unsteadiness, or imbalance, not spinning – that is associated with neck pain or restricted cervical mobility and provoked by cervical movements or positions. It is distinctly different from vertigo, and that distinction matters clinically.

Prevalence estimates range from 5–6% in ENT practices all the way to 40% in patients presenting with neck pain. It’s likely showing up in your practice more than you realize – particularly in patients with chronic neck pain, whiplash-associated disorder, or degenerative cervical changes.

Why Does the Neck Cause Dizziness?

The mechanism involves cervical proprioception – the sensory signals your brain receives from muscles, joints, discs, and ligaments in the cervical spine to help coordinate balance, gaze stability, and spatial orientation. When these signals are disrupted by pain, trauma, muscle dysfunction, or degeneration, the brain receives conflicting information from the neck, vestibular system, and visual system simultaneously.

The result is a sensory mismatch – and for some patients, the brain fails to adapt, leading to persistent dizziness, postural instability, and even autonomic symptoms like nausea and palpitations. Dizziness in chronic whiplash patients, for example, appears to be primarily driven by cervical dysfunction rather than vestibular or concussive injury.

The Diagnostic Challenge

This is where it gets genuinely difficult – and why this paper is so valuable. There is no single test that confirms CGD. It remains a diagnosis of exclusion, requiring clinicians to systematically rule out vestibular, cardiovascular, and neurological causes before attributing dizziness to the cervical spine.

The clinical assessment involves a combination of cervical range of motion testing, palpation, joint position relocation testing, oculomotor evaluation, and specialized tests like the smooth pursuit neck torsion test and the cervical rotation torsion test – the latter showing the strongest diagnostic utility for ruling in CGD.

🔎 What’s in the Full Review
The complete research review covers the full pathophysiology of cervical proprioceptive dysfunction, a detailed breakdown of every diagnostic test (with their evidence base and limitations), and a clinical application section with specific guidance on how to structure your assessment and integrate manual therapy with sensorimotor rehabilitation for CGD. [Access the full review here]

📋 Clinical Teaser

If your patient has neck pain and dizziness together, don’t assume one is incidental to the other – but don’t assume the neck is the cause either. CGD is a real and treatable condition, but diagnosing it correctly requires a systematic, stepwise approach. This review gives you the framework to do that confidently.

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This Week’s Research Review

“Dizziness and Neck Pain: A Perspective on Cervicogenic Dizziness” — published in Frontiers in Neurology (2025), reviewed by Dr. Ceara Higgins.

📄 Access the full review for a couple of dollars: [Link here]

📚 Or subscribe for access to the entire catalogue of new and existing reviews: [Subscription options here]

About the Author

Dr. Shawn Thistle, DC – 20+ years in clinical practice, founder of RRS Education and www.shawnthistle.com, research review and knowledge transfer specialist.