An Osteopathic Strategy for the Recognition and Management of Cervicogenic Vertigo: A Case Study
Introduction: Cervicogenic vertigo (CV) is an imbalance or disorientation associated with neck pain and diminished cervical range of motion. Although the relationship between neck pain and dizziness is not fully understood, these symptoms are associated with somatic dysfunction of the cervical spine. Headaches often result from muscular and myofascial attachments between the cervical spine and cranium. A 67-year-old female presented to the Osteopathic Manipulative Treatment (OMT) clinic with neck pain, radiating to her shoulders, and dizziness described as water sloshing inside her head. She exhibited headaches at the base of her skull, associated with ringing in her ears. She slept elevated on several pillows to avoid dizziness. Upon physical exam, reduced left cervical rotation was observed. OMT included reducing hypertonicity of cervical and upper extremity muscles using direct myofascial release, ligamentous articular strain, soft tissue, and Osteopathic Cranial Manipulative Medicine (OCMM). The patient received 10 sessions of OMT. A Vertigo Symptom Scale was administered, recording different symptom frequencies. The initial score was 22/60 and the last score was 7/60, indicating a decreased frequency of vertigo symptoms with OMT. OMT was shown to increase cervical rotation and decrease the frequency of vertigo symptoms. The patient now sleeps slightly less elevated and on her side, which is her preferred sleeping position, rather than exclusively on her back. This has improved both her sleep quality and subsequently her quality of life. Being that cervicogenic vertigo is a diagnosis of exclusion and therefore underdiagnosed, OMT also provides the unique opportunity to better identify these cases due to advanced knowledge of the musculoskeletal system and the body as a complete, interrelated unit. Further research is needed to establish the role of OMT in treating CV. Case study limitations include controlling for confounding variables such as patient's activity and stress levels.Abstract
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