Treatment of vertigo with a C2 chiropractic adjustment: A case report

Journal of the American Chiropractic Association, Jul 2003 by Wicks, Thomas A

Abstract

Objective: To discuss the case of a patient suffering from vertigo who was successfully treated with a chiropractic adjustment to the C2 vertebra.

Clinical Features: A 53-year-old female presented to the Palmer Clinics via wheelchair suffering from a recurrence of vertigo that resulted in severe dizziness, nausea, vomiting, and an inability to stand or walk. Static palpation revealed taut and tender muscle fibers at the level of C2 along with decreased rotational motion and pinpoint pain.

Intervention and Outcome: The patient was previously treated with a diversified technique in the cervical region, but because of the severe nature of the vertigo upon presentation as well as the fact that she could not stand, walk, or lie on an adjusting table, she was treated with a specific adjustment (rotary break) to the C2 vertebra. Following the adjustment, the symptoms of the vertigo completely disappeared for approximately three (3) minutes. Minimal vertigo returned after this time and was treated by direct digital pressure on the lamina of the C2 vertebra for ten (10) minutes. Following release of the digital pressure, all vertigo symptoms disappeared. The patient was able to stand and leave the clinic unassisted.

Conclusion: Specific chiropractic adjusting of cervical vertebrae may provide a treatment option for selected cases of vertigo. Further study should be made utilizing other adjusting techniques as well as other areas of vertebral subluxation.

Key Words: Chiropractic Vertigo Adjustment

Introduction

Vertigo is a sensation of spinning, dizziness, or of rotation and can be classified as acute, recurrent, or positional.1,2 Acute vertigo may be the result of such things as a vertebrobasilar event, toxicity (illness or drug), infections, trauma, tumor, or seizure. Recurrent vertigo may result from Meniere's disease, migraine, hypothyroidism, multiple sclerosis, seizure, syphilis, or vertebrobasilar transient ischemic attacks (TIA). Positional vertigo includes benign positional vertigo, post-infectious, and post-trauma, cervical, or central causes.

Central vertigo refers to pathologies that emanate from dysfunction of the brainstem, cerebellum, or other supratentorial structures. Peripheral vertigo occurs when dysfunction occurs in the labyrinth, vestibular nerve, or proprioceptive afferent nerves from cervical structures.3 Mixed vertigo can be present when elements of acute, recurrent, or positional vertigo are present.

Symptoms of the various forms of vertigo can include nausea, vomiting, unsteadiness, giddiness, light-headedness, disequilibrium, nystagmus, tinnitus, hearing loss, and cervical pain.4 According to Walling, nausea is often more pronounced when the vertigo is peripheral, and imbalance more severe in central vertigo.5

This article discusses a case report of a patient with peripheral vertigo who was managed by a short-lever, high-velocity chiropractic adjustment to the C2 vertebra.

Case Report

A 53-year-old female presented to the Palmer Clinics in a wheelchair with a chief complaint of vertigo. Prior to her arrival in the clinic, she experienced several episodes of nausea, vomiting, and dizziness. The patient was unable to walk, and riding in the wheelchair aggravated the vertigo to the extent that vomiting occurred again upon her arrival in the clinic.

Her episodes of vertigo began in 1991 and were insidious in origin. The first episode lasted approximately five minutes and reoccurred three times in the following year. One episode produced vomiting and subsequently required hospitalization. She was examined by an otolaryngologist and an ophthalmologist, and had magnetic resonance imaging performed. No abnormalities were detected. A new prescription for eyeglasses was given to the patient and she was given a prescription for diazepam. At the time of her presentation to the Palmer Clinics, she was experiencing approximately one episode of vertigo each month and had been treated in the clinic approximately one time per week for the previous five months.

During her weekly visits to the clinic, the patient was adjusted in the cervical area with either a diversified technique (modified rotary break) or an adjusting instrument (Activator methods adjusting instrument). Both methods of adjusting reduced the number of episodes of vertigo in the days following the adjustment (as reported by the patient).

When she presented to the clinic complaining of vertigo, nausea, and vomiting, she was unable to walk, rise from the wheelchair, or lie on an adjusting table. The examination was performed with the patient seated in the wheelchair and during the procedure she vomited again. Upon questioning about the vertigo, she stated that she had been seen in the clinic for cervical adjusting two times in the previous three days. The patient was questioned about the etiology of the current episode of vertigo. She denied any increase in work or home stress, medication problems, or any other precipitating factor.

The head and neck exam revealed clear tympanic membranes and no evidence of cervical or cephalic bruising or discoloration. Manual palpation of the cervical area revealed taut and tender fibers on the left side of the spinous processes extending from the suboccipital region to the level of C5. In addition, tenderness was present at the level of C2, primarily on the left side. The lamina of C2 was palpated as being more prominent on the left side, suggesting a subluxation of the C2 vertebra (posterior with spinous rotation to the right). Cervical rotation was limited bilaterally due to the reluctance of the patient to rotate her head. Likewise, lateral bend was limited bilaterally. No radiography or instrumentation was performed at this time. Differentiating neurological exams were also not performed at this time due to the symptomatology of the patient and her inability to undergo the exams.