The headaches and neck pain are getting worse. PT, massage, and medications did not help. All the imaging studies are normal. Your doctors are baffled. What is Craniocervical Instability? What are the most common Craniocervical Instability Symptoms? What are the treatment options for Craniocervical Instability? Let’s dig in.
What Is Craniocervical Instability?
Craniocervical Instability (CCI) is a medical condition where the strong ligaments that hold your head to your upper neck are loose or lax (1). The major ligaments involved are the Alar, Transverse and Accessory ligaments. To learn more about CCI please click on the video below.
Craniocervical Instability Symptoms
Excessive movement between your head and neck can cause movement and damage of upper cervical facet joints, discs, nerves, and blood vessels. Symptoms vary depending upon the amount of instability. Common Craniocervical Instability symptoms include:
Painful Heavy Head
A constant to near-constant head pain that can be described as feeling like the head is too heavy for the neck to support. Many describe feeling like they have a “bobble-head”.
Headache
This is not your normal headache caused by your in-laws or excessive consumption of alcohol. This is a debilitating headache that is constant in duration and miserable. Headache is often caused by the upper neck joints, muscles, and tendons getting injured due to ongoing instability.
Rapid Heart Rate
Elevated heart rate may occur as the vagus nerve gets irritated by the extra motion in the upper neck. Another cause of elevated heart rate is Postural Orthostatic Tachycardia Syndrome (POTS). POTS is a medical condition that causes malfunction of the autonomic nervous system. It is estimated to impact between 1,000,000 and 3,000,000 Americans. The autonomic nervous system controls involuntary body functions such as heart rate and blood pressure. Malfunction of the autonomic nervous system causes a number of symptoms which include rapid heart rate.
Brain Fog
Patients with CCI can struggle with memory, concentration, and ability to complete tasks. Every day can feel like your brain is stuffed full of cotton.
Neck Pain
Pain is typically localized at the base of the skull and aggravated with flexion and rotation. The pain can shoot up into the base of the skull, top of the head, frontal area or behind the eyes.
Visual Problems
Visual disturbances can vary from mild to severe involving a number of symptoms. Visual disturbances can happen because the upper neck supplies information to the brain to guide eye position and vice versa (2).
Dizziness
Balance problems can be a significant issue (3). Dizziness or imbalance is a feature related to the fact that the upper neck is a major contributor to balance (4). The upper neck provides position sense that has to be coordinated with balance information from the eyes and inner ear
Diagnosing Craniocervical Instability
In a previous blog, I reviewed the 7 main criteria used in establishing the diagnosis of cranial cervical instability. They are:
- Mechanism of Injury
- Symptoms
- Physical Examination
- Radiographic studies
- Response to Conservative Care
- Response to Diagnostic Injections
- Level of Disability
Treatment Options for Craniocervical Instability
In 2015 a nonsurgical treatment option for cranial cervical instability was developed at the Centeno-Schultz Clinic. It involves the injection of a patient’s own bone marrow-derived stem cells into the damaged alar, transverse ligaments. The procedure is very demanding and only performed at the Centeno-Schultz Clinic in Broomfield Colorado. The procedure is called Percutaneous Implantation of Cervical Ligaments (PICL) To learn more about this groundbreaking procedure please click on the video below.
In Conclusion
Craniocervical Instability (CCI) is a medical condition where the strong ligaments that hold your head to your upper neck are loose or lax. This can involve the alar, accessory, and transverse ligaments. Craniocervical Instability Symptoms vary depending upon the amount of instability. The 7 most common symptoms are a painful heavy head, headache, rapid heart rate, brain fog, neck pain, visual problems, and dizziness. The main criteria for diagnosing craniocervical instability has been previously discussed in a separate blog.
Craniocervial instability if left untreated can result in a progression in symptoms and injury to the cervical discs, facets, muscles, and nerves. In severe cases, patients are housebound due to their level of dysfunction and symptoms. Employment, relationships, and joy often times are eroded.
If you or a loved has sustained an injury with symptoms that baffled your community physicians please schedule a telemedicine consultation. A board-certified, fellowship-trained physician will review your history and imaging to determine your candidacy for nonsurgical treatment options. Act now before the symptoms and dysfunction progress.
1.Offiah CE, Day E. The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma. Insights Imaging. 2017;8(1):29–47. doi:10.1007/s13244-016-0530-5
2.Ischebeck BK, de Vries J, Van der Geest JN, et al. Eye movements in patients with Whiplash Associated Disorders: a systematic review. BMC Musculoskelet Disord. 2016;17(1):441. Published 2016 Oct 21. doi:10.1186/s12891-016-1284-4
3. Biesinger E. and Vertigo caused by disorders of the cervical vertebral column. Diagnosis and treatment. Adv Otorhinolaryngol. 1988; 39: 44– 51.
4. Thompson-Harvey A, Hain TC. Symptoms in cervical vertigo. Laryngoscope Investig Otolaryngol. 2018;4(1):109–115. Published 2018 Nov 28. doi:10.1002/lio2.227