Vertigo after a Motor Vehicle Accident

Symptoms by body part:

Vertigo: A disorder of the Vestibular System, and is a spinning sensation of yourself or the world around you. 

Vertigo is a false perception of movement of self or surroundings (7). This can be caused by some of the more common conditions such as BPPV, Meniere's disease, Vestibular Neuritis or Labyrnthitis, also can be caused by neck/head injury such as Concussion or Whiplash, Brain problems such as stroke or tumor, Migraines, Functional causes and Medications. There are other causes, but these are a few of the more common causes, BPPV (Benign Paroxysmal Positional Vertigo) being the most common (9). 

We need to have balanced sensory signals to our brain to know where we are in relation to the space around us

Proper orientation in space requires accurate and consistent input from the proprioceptive, visual and vestibular sytems. If one or more of these systems provide inaccurate information about spatial location, alternation in balance and dizizness may result due to mismathcing of sensory information. Post-traumatic dizziness is believed to occur secondary to benign paroxysmal positional vertigo, central vestibular, peripheral vestibular, visual or proprioceptive systems (10).  

Typical patients treated in our office are due to either peripheral and central vestibular conditions, or a combination of both. Most commonly treated Vertigo related conditions at Portland Chiropractic Neurology are

• Concussion
• Whiplash injury (motor vehicle accident or other)
• Neck injury
• BPPV
• Vestibular Neuritis/Labrynthitis that has remained symptomatic after steroid treatments or other
• Idiopathic, or unknown cause of Vertigo, which typically represents a functional issue
• Central Vestibulopathies

Benign paroxysmal positional vertigo (GPPV) is the most common peripheral vestibular end-organ disease and is typified by a sudden, transient gyratory sensation which is accompanied by characteristic nystagmus and provoked by positional head changes (1). 

Dizziness and Neck pain are both common complaints. Previous studies have shown that concurrent dizzines and neck pain are common in both patients with dizziness and patients with neck pain as their presenting complaint. Dizziness is a complex symptoms, and in the absence of other diagnosis or explanations, concurrent neck pain is sometimes suspected to play a role. Anatomically and physiologically, the vestibular and cervical proprioceptive systems are closely linked (2). Neck pain has been found to be an independent predictor of long-term dizziness (3). In theory, pain may lead to a disruption or alteration in the cervical afferent information, causing a sensory mismatch, resulting in a sensation of dizziness (4). Dizziness of Cervical origin is usually thought to manifest itself as an unpleasant or vague feeling of dizziness without a strong sense of rotation (6). 

According to the Barany society's committee for the classification of vestibular disorders, the terms 'vertigo' and 'dizziness' are non-hierarchical and reflect distinctly separate sets of symptoms. They define vertigo as a false sense of self-motion with normal movement. They have further sub-classified vertigo into internal and extenral, for separating the vestibular sense of false motion form the visual sense of false motion (8)

Vertigo is defined as a false sense of self-motion without any motion or the feeling of distorted self-motion with normal movement (7). Therefore, there is a signal error somewhere between the inner ear, brain stem and cortex that is creating a sensory mismatch, resulting in feeling of movement that must be diagnosed and treated such as is available through the care at Portland Chiropractic Neurology. 

How can we diagnose what's causing your Vertigo? 

By evaluating the brain and nervous system in its entirety, but specifically along the cervicovestibular pathway, we can localize regions that are dysfunctional and misrepresenting sensory information of spatial orientation to the brain. Autonomic dysregulation can cause dysfunction in the vestibular system and we perform careful evaluation of this potential involvement. Oxygenation is an important aspect of neurological function and is also evaluated very carefully. We're essentailly looking at your brain from an integration perspective, ensuring all regions are sending appropriate afferent information to the brain, including the vestibular system, proprioceptive system, visuomotor system, autonomic system, and oxygenation system. Our core model of care is multi-modal, ensuring that all potential regions that may contribute to Vertigo are properly assessed and treated to allow proper function to occur between the inner ear and brain stem/cortex. In order to do this, we must reset the Central Integrated State of the dysfunctioning neuronal regions involved with your Vertigo. We attempt to achieve this through a specialized program that combines Neurology, Chiropractic, Physical Therapy, Vestibular Rehabilitation, Occupational Therapy and Oxygen. 

Vestibular Core Testing:

• Videooculography (VOG, sometimes referred to as VNG) that measure eye movements that relate to specific regions of the brain, brain stem and vestibular system.
• Sensitive balance and coordination testing of proprioception and brain using Computerized Assessments of Posturography Systems (CAPS) that allow us to measure dysfunctional areas sensory input related to Vertigo.
• Tilt Table Testing
• Autonomic Assessment
• Clinical Examination (Neurology, Proprioceptive, Respiration)
• Gait analysis
• Oxygen evaluation
• Metabolic capacity
• Objective measures
• Spatial and Temporal Summation (Treatment Plan)

Vestibular Core Treatment:

• Tilt Table Treatment (TTT)
• Non-Invasive Nerve Stimulation (NINS)
• Vagus Stimulation (VS)
• Oculomotor retraining (eye movement exercises) (OMR)
• Vestibular Rehabilitation (VR)
• BPPV repositioning maneuvers
• Vestibular Repositioning Maneuvers
• Occupational Therapy (OT)
• Rib Manipulation (RM)
• Cervicovestibular rehabilitation (CVR)
• Specific Chiropractic Neurological Manipulations for Oxygenation L/S/T (SCNM-O)
• Mild Hyperbaric Oxygen Therapy (mHBOT)
• Postural Restoration (PR)
• Physical Therapy (PT)
• Functional Neurological Rehabilitation/Neuroplasticity Retraining Exercises (FNR/NRE)
• Co-treatment (Botox, Medications, etc..) (CT)
• Migraine dietary recommendations (MDR), if applicable

How can our treatments change your Vestibular response? 

Neurons require Activation, Oxygen and Fuel (glucose) to maintain a healthy state of -65 mV and undergo Immediate Early Gene Response to create more cellular contents such as sodium/potassium pumps, mitochondria for ATP formation, axonal and dendritic connections with neighboring cells, etc. The list you saw is how we target the dysfunctional areas with activation, oxygen and carry fuel to those cells. This has to be done in a very graded, careful manner so as to not exceed the metabolic rate of the neurons involved. We observe metabolic capacity for each individual and maintain levels of treatment that stay below those levels so as to keep a steady progression of healthy return to a normal state of function. Neurons respond through Temporal and Spatial Summation, so we can develop treatment plans based on your severity that will allow maximal response and long-term changes. This is known as Neuroplasticity and is at the core of our Vestibular Program. I often tell people, I don't know how much I can help you, but in many cases, we're at least able to improve to 50% with the understanding that our goal is much higher. Your response depends on multiple factors, including genetics, central sensitization (chronicity), following our treatment plan and so forth. We are very open and honest with our patients and do our best to provide accurate information, but it is a functional issue and it is difficult to be exacting in our predictions. 

Can Portland Chiropractic Neurology treat my Vertigo successfully? 

For many individuals, yes we can, and we've been doing it for many years. However, that can range from 0% improvement to as close to 100% as possible, although most people will agree that an improvement of 50% is life changing. The rest we hope to control through lifestyle changes, dietary changes, Medical intervention such as medications, botox, etc.  Our goal is for your results to be long-lasting and permanent without our continued care because we utilize Neuroplasticity appropriately along all aspects of our treatment plan, patients don't return to their previous state when they are finished treatment. That being said, genetics and many other aspects play a role in your Vestibular physiology, so it is difficult to determine or know for sure at the beginning of treatment if you are a 50% improved patient or a 100%, or anything in between. With the proper diagnosis, we can treat the areas that are the primary source of your Vertigo through Neuroplasticity Retraining Excercises that will change brain function involved with your Vestibular system. 

(1) You Peng, MD, Instrum Ryan, MD, Parnes Lorne, MD, FRCSC. Benign paroxysmal positional vertigo. Laryngoscope Investigative  Otolaryngology. 2019 Feb: 4 (1): 116-123. 

(2) Knapstad, Mari Kalland, et al. Neck pain associated with clinical symptoms in dizzy patients- A cross-sectional study

(3) Wilhelmsen, K., et al. Psychometric properties of vertigo symptom scale-Short form. 2008. BMC Ear, Nose, and Throat Disorders, 8(1), 1-9. 

(4) Brandt, T., & Bronstein, A.M. (2001) Cervicao vertigo, Journal fo Neuroogy, Neurosurgery and Pyschiatry, 71 (1), 8-12. 

(5) Devaraja, K. (2018). Approach to cervicogenic dizziness: A comprehensive review of its aetiopathology and management. European Archives of Oto-Rhino-Laryngology, 275 (10), 2421-2433. 

(6) Thompson-Harvey & Hain, 2019. Symptoms i cervical vertigo. Laryngoscope Investig Otolaryngol, 4(1), 109-115. 

(7) Devaraja, K. Approach to cervicogenic dizziness: a comprehensive review of its aetiopathology and management. European Archives of Oto-Laryngology (2018) 275:2421-2433 

(8) Bisdorff A, et al. (2009) Classification of vestibular symptoms: towards an internal classification of vestibular disorders. J Vestib Res Equilib Orientat 19:1-13 

(9) https://www.webmd.com/brain/vertigo-symptoms-causes-treatment#1 

(10) Scheider KJ, et al. Cervicovestibular rehabilitation in sport-related concussion: a randomized controlled trial. Br J Sports Med 2014; 48:1294-1298