Table 3 Presentation of cervicogenic dizziness and competing diagnoses

Acute Vestibular Loss

Single attack, several attacks, or persistent for several weeks.

Sudden vertigo or dizziness possibly accompanied by tinnitus, diplopia, nausea, vomiting [15].

Benign Paroxysmal

Positional Vertigo

A few seconds to several minutes.

Vertigo. Occurs with changes in position relative to gravity [50].

Central Vestibular Disorders

Several days to weeks.

Constant vertigo, facial asymmetry, swallowing or speech problems, ptosis, ataxia, sensation changes, upper motor neuron signs, abnormal head thrust test, direction changing nystagmus, pure vertical nystagmus, pure torsional nystagmus, a skew deviation, and other neurological symptoms [23, 51].

Cervical Arterial Dysfunction

Several minutes.

Dizziness that is typically accompanied by diplopia, numbness around the lips, nystagmus, ataxia, bilateral neurological symptoms, dysphagia, dysarthria and headaches. Associated with nausea and vomiting [19].

Cervicogenic Dizziness

Several minutes to hours [3].

Dizziness and disequilibrium due to changes in cervical spine position [3].

Labyrinthine Concussion

Episodically over hours to days [26].

Cervical neck pain is common. Hearing loss, tinnitus, and dizziness [18].

Ménière’s Disease

Minutes to hours, rarely longer than 24 h [12].

Presents with episodic, intense vertigo, accompanied by aural fullness, tinnitusand fluctuating hearing loss. Attacks are typically preceded by aura and followed by a period of exhaustion and generalized dizziness. As Ménière’s disease progresses, the hearing loss and tinnitus intensify and become more persistent, and the acute attacks of vertigo may be replaced by more chronic problems with dizziness and imbalance [12, 13].

Vestibular Migraine

4–72 h.

Vestibular Migraine Diagnostic Criteria (International Headache Society) [17].

 A. At least five episodes involving criteria C and D.

 B. A current or past history of Migraine without aura or Migraine with aura.

 C. Vestibular symptoms* of moderate or severe intensity, lasting between 5 min and 72 h.

 D. At least 50% of episodes are associated with at least one of the following three migrainous features: 1) headache with at least two of the following four characteristics: unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity; 2) photophobia and phonophobia; 3) visual aura.

 E. Not better accounted for by another ICHD-3 diagnosis or by another vestibular disorder.

*Barany Society’s Classification of Vestibular Symptoms:

a. spontaneous vertigo:

 i. internal vertigo (a false sensation of self-motion)

 ii. external vertigo (a false sensation of visual surroundings spinning or flowing)

b. positional vertigo, triggered by a complex or large moving stimulus

c. visually induced vertigo, triggered by a complex or large moving visual stimulus

d. head motion-induced vertigo, occurring during head motion

e. head motion-induced dizziness with nausea

Whiplash Associated Disorder

Variable. Days to weeks and in some cases months.

Cervical neck pain and hypersensitivity, decreased cervical range of motion, dizziness, tinnitus, and headache. Associated with psychological factors, such as low pain tolerance and fear avoidance [21].