Cervicogenic Headaches and Dizziness

The Global Burden of Disease study ranks headache disorders as the 2nd leading cause of years lived with disability worldwide (Saylor and Steiner 2018). Three common types of headaches exist: migraines, tension-type headaches or cervicogenic headaches.

Cervicogenic headaches are secondary headaches that are related to a disorder in the upper joints of the neck. It is a referred pain, meaning the pain is perceived to be felt in the head, although the source of the pain is the neck. Similarly, cervicogenic dizziness is characterised as dizziness or “vertigo”-like symptoms that are a result of upper neck (cervical spine) dysfunction or injury.

What causes cervicogenic headaches or dizziness?

Because numerous pain sensitive structures exist around the neck (cervical spine) and the back of the head (occipital) region, irritation to structures in this area can result in headaches or dizziness-like symptoms. Working in poor postures or sustained neck positions can cause excessive strain and load to the upper joints of the neck, leading to dysfunctions in the muscles around the neck. Traumatic injuries including motor vehicle accidents, sporting injuries or falls, can also damage these joints. Osteoarthritis, or age-related changes can develop in these joints in older populations, resulting in cervicogenic symptoms.

How do I know if I have a cervicogenic disorder?

A person with cervicogenic headaches will often have reduced neck range of motion, symptom reproduction when touching areas around the neck and associated neck pain. Headaches usually start at the back of the head or neck and can radiate to the front of the head or behind the eyes. Symptoms can be aggravated after being in one position for a prolonged period (i.e. sitting at a desk) or with neck movement. About one third of people with cervicogenic headaches will also report light-headedness, unsteadiness or visual disturbances (APA website). A person with cervicogenic dizziness will similarly have limited neck movement, neck pain, and can report symptoms of unsteadiness, imbalance or disorientation (Reily et al. 2017).

How can Enhance Physiotherapy treatment help?

There is high quality evidence that supports the use of manual therapy and exercise for managing cervicogenic headaches (Gross et al 2015; Hall et al 2007; Jull et al 2002; Racicki et al 2013) and dizziness (Jull et al 2007; Reid and Rivett 2005; Reid et al 2007). Your Enhance Physiotherapist may use different manual therapy techniques, taping, dry needling and prescription of strengthening exercises to help treat your symptoms.

If you believe you may suffer from a cervicogenic disorder, an adequate and thorough assessment by an Enhance Physiotherapist is essential in correctly diagnosing and excluding from other conditions. This is because different headache and dizziness conditions require different treatment and management plans. At Enhance Physiotherapy, our physiotherapists specialize in upper cervical spine disorders and can thoroughly assess your condition, provide a diagnosis with treatment plan or refer you to the appropriate medical practitioner if necessary.

Book your Enhance experience online today or call us on 9583 5165


Saylor and Steiner. The Global Burden of Headache. Semin Neurol 2018:38

BPPV – Benign Paroxysmal Positional Vertigo


What is BPPV?

BPPV stands for Benign Paroxysmal Positional Vertigo and is usually characterised by an intense, brief episode of dizziness associated with head movement, often when rolling over in bed or getting up in the morning.

Benign – not life threatening or sinister
Paroxysmal – it comes on suddenly, but usually short lasting
Positional – triggered by certain head positions or movements
            Vertigo – a false sense of spinning or dizziness

In our vestibular system, located in our ear, we have 3 canals in which fluid passes through stimulating tiny receptors that send messages to alert the brain of any head rotation or movements. The brain receives the messages and we can then adjust our eyes and posture accordingly. The normal fluid travelling within the canals do not react to gravity.
When BPPV occurs, a tiny crystal is formed and enters the vestibular system through one of the canals. As the crystal is heavier than the fluid moving through these canals, it reacts with gravity when our head is turned, causing the brain to receive a false message that the head is spinning at a much faster rate than what is happening. Therefore, there is a mismatch in messages between what the ears are sensing and what the eyes are seeing or how our body is reacting, resulting in a spinning experience or dizzy sensation.

What Are The Symptoms of BPPV?

The main and most common symptoms are a sensation that the room is spinning, dizziness, light-headedness, imbalance or nausea. These symptoms usually occur with change in body position. An external person will observe your eyes rapidly moving, this is known as nystagmus.

BPPV symptoms usually last a few seconds, this is until the crystal comes to rest in the canal due to gravity. It is important to know that BPPV will not give you constant dizziness that is unaffected by movement or a change in position. It will not affect your hearing or elicit neurological symptoms such as numbness, pins and needles, trouble speaking, weakness or difficulty co-ordinating your movements.

Why Do People Get BPPV?

The exact cause or reason for BPPV still is unknown; however, research has linked the following causes to cases of BPPV;

  • Head injury
  • Degeneration of the vestibular system in the inner ear due to ageing
  • Damage caused by an inner ear disorder
  • Illness such as the flu or viral symptoms

How is it Diagnosed?

Normal medical imaging (e.g. MRI) is not effective in diagnosing BPPV; however, a trained physiotherapist or doctor is able to assess a patient and diagnose the condition through a series of tests and head movements. A positive BPPV test returns when a patient displays nystagmus (rapid eye movements) and/or their dizziness symptoms. The most common manoeuvre to assess is called a Dix-Hallpike.
The aim of assessing and diagnosing is to reproduce your symptoms; therefore, it is advised that a patient be accompanied and driven to their appointment or that they are to wait in the waiting room after their treatment until they are safe to drive home.

How is it Treated?

Many patients are given medication for BPPV from their doctor; however, these medications usually just mask the symptoms.
Majority of cases can be corrected manually by your Enhance Physiotherapist. Once the affected canal is identified and the type of BPPV is determined, you will undergo the appropriate manoeuvre which makes use of gravity to guide the crystals back to the appropriate chamber where they are supposed to be. The most common manoeuvre is called the Epley Manoeuvre.

What Happens After Treatment?

Many studies have shown that the above technique has a high success rate after the first treatment. In some instances, the crystals may be more stubborn and require multiple treatments. There can also be more than one canal involved; however, only one canal can be treated at a time.
Even once the crystal has been successfully returned to the correct chamber, some people can be left with residual dizziness or fatigued feeling. Your Enhance Physiotherapist can give home-based exercises to address this.

Will it Come Back?

Unfortunately, BPPV is a condition that can re-occur periodically, especially those related to trauma. There are other conditions that can mimic BPPV symptoms, so it is always advisable to have a thorough assessment performed by an Enhance Physiotherapist and a diagnosis given before commencing treatment.

Book your Enhance Experience online, or call us today.


Peng You, R. I. (2019, February). National Center for Biotechnology Information. Retrieved from Benign Paroxysmal Positional Vertigo: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383320/pdf/LIO2-4-116.pdf

Benign Hypermobility Syndrome and Other Disorders

Enhance Physiotherapy is pleased to offer our patients treatments and other options for management of chronic health conditions such as benign hypermobility syndrome, fibromyalgia and other rheumatoid and body disorders, as part of our comprehensive services.


Benign Hypermobility Syndrome, or BJHS is a connective tissue disorder that can lead to hypermobility, where musculoskeletal symptoms occur without a systematic rheumatologic disease. This syndrome is thought to be an inherited disorder. BJHS clinically presents with hypermobility and pain in multiple joints. It is different from other disorders that cause local joint hypermobility and generalized joint laxity such as Ehlers-Danlos Syndrome and Marfan Syndrome; all of which an Enhance Physiotherapist can help with structuring a treatment plan to suit your individual condition.

When a patient first presents with BJHS the chief complaint is general joint pain so Benign Hypermobility Syndrome can be easily overlooked and not considered in a diagnosis. Here at Enhance Physiotherapy we follow a complete assessment that uses the Beighton criteria to facilitate the diagnosis of BJHS.

Fun Fact – generalized joint laxity is commonly seen in healthy individuals who do not have complaints. Hypermobility that is not associated with systemic disease occurs in 4% to 13% of the population. Hypermobility diminishes with age and it appears to be related to sex and race.

Fibromyalgia, is a common condition that affects a large population.  It is characterized by symptoms of widespread pain and tenderness in the body often accompanied by fatigue and problems with concentration. At Enhance Physiotherapy, we offer thorough assessment of pain structures to assist in designing a specific individualized treatment plan to ensure your goals are met and pain is well-managed.

Other Disorders of the body arthritis/rheumatoid arthritis and other such conditions, Enhance Physiotherapy and our highly trained exercise physiologists and physiotherapists are here to help with diagnosis, maintenance, management and giving you the ability to achieve your goals and live your best life. Through individualized treatment plans and programs focusing on your goals; not your limitations of your pain, together, we can achieve anything and everything.

Book your Enhance experience online today or call us on 9583 5165