Marc Darrow, MD. JD.
For many years doctors have speculated that a weak neck or cervical spine instability could be at the root of a long list of non-responsive neurologic, psychological, and cardiovascular symptoms. More specifically symptoms of depression, anxiety, cognitive problems and memory loss, hallucinations, fainting, the sensation of seasickness, dizziness, vertigo, hearing problems, vision problems, swallowing, digestive problems including chronic nausea, numbness, headaches, muscle wasting, breathing problems, to name but just a few may be traced to neck problems.
If a weak neck or cervical spine instability is the cause of these problems, what caused the cervical spine instability? The answer can be found in the cervical spine ligaments that hold the bones of the neck together. When these strong connective tissues are stretched out or loose from years of poor posture, degenerative wear and tear, whiplash and sport injury, or possibly disorders such as Ehlers-Danlos Syndrome, the bones of the neck, namely the vertebrae can move out of alignment and press down on nerves and vital blood vessels that travel between the heart and brain.
These symptoms impact people’s lives terribly. Worse for many is that they have all these symptoms and doctors are at a loss to provide a diagnosis and a treatment pan to help them.
From brain to body, everything goes through the neck
The neck is the main thoroughfare from which signals go from the brain to the various components of our nervous system and back. Through the neck run the vital left side and right side vagus nerves. As shown in the illustration below, the vagus nerve is responsible for providing, processing and sharing information between the brain and the lungs, heart, liver, stomach, and intestines.
Doctors have speculated that compression of the vagus nerve in the neck is associated with problems related to these organs.
Other symptoms that may give clues that a person’s problems is coming from neck instability:
- Swallowing difficulty.
- Increase in anxiety drive behavior and panic attacks.
- Digestive disorders.
A 2018 paper (1) suggested that cervical spondylosis, (degenerative osteoarthritis of the neck) is associated with a 3.10-fold increase of arrhythmia risk compared to patients without cervical spondylosis, especially atrial fibrillation, ventricular and supraventricular tachycardia (racing heart rate.) The paper points out further: “Clinical evidence had shown that cervical spondylosis can cause sympathetic nerve irritation and associated sympathetic symptoms (Recognized sympathetic symptoms of cervical spondylosis are vertigo, dizziness, tinnitus, headache, and palpitation.)” How? the suggestion is that “instability at the C4–C5 intervertebral space is the most-common type causing sympathetic symptoms.” This instability can result in “a higher risk of developing atrial fibrillation, atrial flutter, and ventricular tachycardia.”
The Microbiota-gut-brain axis and depression
A November 2022 review study (2) explore the connection between gut and depression. “Cumulate research” the researchers say, “suggests that a disturbance of microbiota-gut-brain axis may play a vital role in the etiology of depression while correcting this disturbance could alleviate depression symptoms. . . Depression is more than a mental disease but with substantial physiological and anatomic alterations including decreased (mental function), dysfunction of neural circuits, and unbalanced neurotransmitters. . . . The Vagus Nerve possesses an anti-inflammatory and gut barrier protective role which is inhibited in response to stress, a risk factor of depression. It is likely that the depressed vagal tone may facilitate the gut bacteria translocation and system inflammation, promoting the onset and deterioration of depression.”
A November 2020 paper in The international tinnitus journal (3) suggested that “treating cervical spine disorders can reduce tinnitus.” In this study “a group of tinnitus patients, 19% of the patients had less tinnitus after therapy of the C3 and C4. Screening of tinnitus patients is needed for the proper selection of the ones who could benefit from a somatic approach.” The somatic approach addresses a subtype of tinnitus “somatic tinnitus” also referred to as “somatosensory tinnitus.” This tinnitus is caused by among other things, spasms of the neck and jaw muscles., therefore certain treatments are offered to address this problem. This would included: stretching exercises of the suboccipital muscles; lidocaine injections into jaw muscles; chiropractic care; myofascial trigger point injections; Transcutaneous nerve stimulation (TENS); Botulinum toxin type A injections; PRP inections, muscle relaxants.
A 2017 paper (4) suggested that the branches of the vagus nerve that innervate the liver and serve an important role in liver-brain connection also provides anti-inflammatory instructions during liver disease. Also suggested was accumulated evidence that clearly demonstrate, autonomic dysfunction (functional problems with involuntary body functions such as heart beat) which is reduced functioning of both vagal and sympathetic nervous system, occurs during chronic liver disease and is well-known complication of patients suffering from cirrhosis. . . .Considering the fact that sepsis is major cause of death in cirrhotic patients, convergence of these findings, may lead to designing novel therapeutic strategies in the field of chronic liver diseases management involving selective drug targeting and electrical nerve stimulation (of the vagus nerve.)
Reduced blood flow to the brain
A 2016 paper (5) connected loss of cervical lordosis (the natural curve of the neck) to disrupted blood flow to the brain by way of blockage of the vertebral arteries. The vertebral arteries provide 20% of the blood circulation to the brain). The researchers showed that the vertebral arteries travel in close anatomical relationship to the cervical spine. When the cervical spine is out of alignment the bones can cause compression or stretching on the arteries.
It is not uncommon for us to see people with a long history and multiple diagnoses for the headaches they suffer from, also have a complaint of serve neck pain and spasms in their upper back and shoulder. They also may tell me about a history of chiropractic manipulations that are generally helpful but do not hold. Some will also suffer from other conditions that may be related to their headaches such as TMJ disorders of the jaw. While many are being managed with conservative care options. Some of these patients will ultimately be recommended to surgery.
A July 2019 paper (6) wrote: “The cause of unremitting head and neck pain in some patients may be compression of the lesser and greater occipital nerves by the posterior cervical muscles and their fascial attachments at the occipital ridge with subsequent local perineural inflammation. The resulting pain is typically in the sub-occipital and occipital location, and, via anatomic connections between extracranial and intracranial nerves, may radiate frontally to trigeminal-innervated areas of the head. Migraine-like features of photophobia and nausea may occur with frontal radiation. Occipital allodynia is common, as is spasm of the cervical muscles. . . Extracranially-directed treatments such as occipital nerve blocks, cervical trigger point injections, botulinum toxin and monoclonal antibodies directed at calcitonin gene related peptide, which act primarily in the periphery, may provide more substantial relief for unremitting head and neck pain; additionally, decompression of the occipital nerves from muscular and fascial compression is effective for some patients, and may result in enduring pain relief. ”
1 Lin SY, Hsu WH, Lin CC, Lin CL, Tsai CH, Lin CH, Chen DC, Lin TC, Hsu CY, Kao CH. Association of arrhythmia in patients with cervical spondylosis: a nationwide population-based cohort study. Journal of Clinical Medicine. 2018 Aug 23;7(9):236.
2 Tan C, Yan Q, Ma Y, Fang J, Yang Y. Recognizing the role of the vagus nerve in depression from microbiota-gut brain axis. Frontiers in Neurology. 2022;13.
3 Koning HM. Upper Cervical Nerves Can Induce Tinnitus. The International Tinnitus Journal. 2020 May 12;24(1):26-30.
4 Hajiasgharzadeh K, Baradaran B. Cholinergic anti-inflammatory pathway and the liver. Advanced Pharmaceutical Bulletin. 2017 Dec;7(4):507.
5 Bulut MD, Alpayci M, Şenköy E, Bora A, Yazmalar L, Yavuz A, Gülşen İ. Decreased vertebral artery hemodynamics in patients with loss of cervical lordosis. Medical science monitor: international medical journal of experimental and clinical research. 2016;22:495.
6 Blake P, Burstein R. Emerging evidence of occipital nerve compression in unremitting head and neck pain. The journal of headache and pain. 2019 Dec;20(1):1-7.