Dizziness That Won’t Go Away? The Upper Cervical Spine May Be the Missing Link

Have you tried the Epley maneuver, vestibular therapy, or medications—yet your dizziness still hasn’t resolved?
If so, you’re not alone. Many people with chronic or recurring dizziness are told their inner ear is the problem, only to find that standard approaches don’t fully address what they’re experiencing.

At Koru Chiropractic, we often see patients whose dizziness has a mechanical and neurological origin in the upper cervical spine, particularly at the junction where the head meets the neck.

When Dizziness Isn’t Just an Inner Ear Problem

Dizziness, vertigo, ear fullness, ringing in the ears, and even sudden “drop attacks” can stem from multiple overlapping systems, including:

• The vestibular system (inner ear)
• Visual input
• Proprioception (joint position sense)
• Autonomic nervous system regulation
• Blood flow in and out of the brain

When dizziness does not respond to vestibular maneuvers or therapy alone, it’s often worth asking a deeper question:

Could the problem be coming from the cranio-cervical junction?

The Cranio-Cervical Junction: Where Structure Meets Neurology

The cranio-cervical junction includes:

• The occiput (base of the skull)
• C1 (atlas)
• C2 (axis)

This region is uniquely vulnerable to injury from:

• Whiplash
• Concussions and mild traumatic brain injury (mTBI)
• Falls (ice skating, biking, skiing)
• Repetitive micro-trauma over time

What’s important—and often overlooked—is that symptoms don’t always show up right away. Research shows that cervical spine injuries can contribute to dizziness and balance disturbances years after the original trauma, even when neck pain has long resolved (Treleaven, PubMed).

Why Symptoms Can Appear Years Later

Many patients report a pattern like this:

• A significant injury earlier in life
• Years of minimal symptoms
• Gradual development of neck stiffness or arthritis
• Sudden onset of dizziness, ear symptoms, or autonomic issues

This progression aligns with research linking degenerative or positional changes in the upper cervical spine to cervicogenic dizziness (Wrisley et al., PubMed).

The Carotid Sheath, Vagus Nerve, and Dizziness Connection

One of the most important—but least discussed—structures in this region is the carotid sheath.

The carotid sheath contains:

• The carotid artery (blood flow to the brain)
• The jugular vein (blood flow out of the brain)
• The vagus nerve (a major autonomic nerve)

The vagus nerve is especially significant. Roughly 80% of its fibers are sensory, constantly relaying information from the body to the brain about blood pressure, inflammation, and organ function (Berthoud & Neuhuber, PubMed).

When the atlas (C1) becomes rotated or shifted, it can approximate toward structures like the styloid process, reducing space for the carotid sheath. Advanced imaging has made it increasingly clear that asymmetrical compression or irritation in this area may influence both blood flow and autonomic signaling, potentially contributing to dizziness, lightheadedness, and ear symptoms.

Why Traditional Imaging Can Miss This

Standard two-dimensional X-rays and even many MRIs are excellent for evaluating soft tissue or gross pathology—but they often miss subtle rotational or spatial relationships in the upper cervical spine.

Cone Beam CT (CBCT) allows for:

• True 3D visualization of C0–C2 alignment
• Sub-millimeter anatomical detail
• Slice-by-slice analysis of bony relationships
• Correlation with soft tissue findings from MRI

This level of precision helps clinicians better understand how structural alignment may be influencing neurological and vascular function, especially in complex dizziness cases.

A Gentle, Upper Cervical–Specific Approach

At Koru Chiropractic, we specialize in upper cervical chiropractic care, including NUCCA (National Upper Cervical Chiropractic Association).

This approach differs from traditional chiropractic in key ways:

• No twisting, cracking, or forceful manipulation
• Highly specific, low-force adjustments
• Focus on restoring balance at the cranio-cervical junction
• Emphasis on neurological regulation rather than symptom suppression

Clinical literature supports the concept that cervical spine dysfunction can influence dizziness and postural control, and that conservative, manual approaches may benefit selected patients when appropriately applied (Reid & Rivett, PubMed).

Why Some Patients Experience Rapid Change

When dizziness is driven by mechanical irritation rather than inner-ear pathology, restoring normal alignment and reducing neural irritation can sometimes lead to noticeable improvement—even after other therapies have failed.

Patients often report:

• Reduced dizziness or vertigo
• Less ear fullness or ringing
• Improved balance and clarity
• Better sleep and nervous system regulation

These changes reflect improved autonomic and sensory integration, not just symptom masking.

When to Consider an Upper Cervical Evaluation

You may want to explore this approach if you:

• Have persistent dizziness despite vestibular care
• Have a history of concussion or whiplash
• Experience ear symptoms without clear ENT findings
• Feel worse with head or neck positioning
• Want to avoid long-term medications or invasive procedures

A More Complete Way to Look at Dizziness

Dizziness is rarely caused by one system alone. When care focuses only on the inner ear, important contributors—like the upper cervical spine and autonomic nervous system—can be missed.

By combining:

• Advanced 3D imaging
• Neurologically focused assessment
• Gentle, precise correction

…we aim to address root causes, not just manage symptoms.

If you’re looking for a novel, evidence-informed approach to unresolved dizziness, we invite you to learn more about upper cervical chiropractic care and how we approach these complex cases at Koru Chiropractic.

References

1. Treleaven J. Dizziness, unsteadiness, visual disturbances, and postural control after neck trauma. PubMed ID: 20625073
2. Wrisley DM, et al. Cervicogenic dizziness: a review of diagnosis and treatment. PubMed ID: 15806037
3. Berthoud HR, Neuhuber WL. Functional and chemical anatomy of the afferent vagal system. PubMed ID: 19468702
4. Reid SA, Rivett DA. Manual therapy treatment of cervicogenic dizziness. PubMed ID: 19787546