Chronic Neck Pain and Dizziness: A Neurology Perspective

I'm not sure where the problem lies?

Hello, doctor! For the past 6-7 years, I have been experiencing 1.
persistent stiffness in my neck and shoulders.
Whenever this stiffness occurs, I feel a pressure in my temples and forehead, as if a rope is tied around or gripping me, followed by dizziness.
(Additionally, when I tilt my head back, I also feel tightness in my neck.) I often find myself in this state all day or intermittently.
2.
Over the past few years, I occasionally experience clear dizziness, but without tinnitus or nausea.
However, sometimes I am unsure if the dizziness is due to spinning or another type of vertigo.
I often feel disoriented, especially when lying down, which makes me feel very dizzy and uncomfortable throughout the day.
I wonder if this could be related to poor sleep quality? Is this considered vertigo? 3.
I have visited an otolaryngologist, but the doctors did not provide any specific insights.
4.
A neurologist conducted an EEG and found an abnormality: Theta waves at 5-7 Hz with an amplitude of 30-35 µV, indicating mild regional cortical dysfunction in the right hemisphere.
5.
A cervical spine X-ray showed degenerative changes with the formation of bone spurs.
6.
In recent years, I have occasionally felt my heart racing.
However, tests including echocardiography, 24-hour Holter monitoring, resting ECG, and exercise stress tests did not reveal any significant issues.
7.
I also underwent carotid and intracranial ultrasound, which showed left IMT of 0.50 and right IMT of 0.67.
8.
In my blood tests, the following values were noted: cholesterol: average 220-245; high-density lipoprotein: average 37-45; low-density lipoprotein: average 140-200; triglycerides: average 150-200; uric acid: 7.5; GPT: 51-88; D-Dimer: 1800 (recommended for further testing during health check-up).
9.
Sometimes, when I squat and stand up or get up from bed, I experience temporary dizziness.
10.
In recent years, I often feel dizzy upon waking up, but occasionally feel better after starting work.
Since this condition occurs almost daily, I really don't know what the problem might be.
Could it be autonomic nervous system dysfunction?

QQ, 30~39 year old female. Ask Date: 2021/08/03

Dr. Jiang Junyi reply Neurology

Dear Mr.
QQ,
I am unsure if you have metabolic syndrome (characterized by abdominal obesity, hypertension, elevated fasting blood glucose, and high lipid levels).
If you do, you may be at high risk for cardiovascular diseases.
You mentioned several issues that seem related to metabolic syndrome: sleep apnea, cervical degeneration, right-side intima-media thickness (IMT) greater than that of peers, low HDL, and elevated LDL.
I recommend that you start considering lifestyle modifications.
You mentioned the possibility of autonomic nervous system abnormalities.
A simple 10-minute analysis of heart rate variability can provide insight into your current condition.
However, I suggest making lifestyle adjustments first, as clinical observations often reveal that poor sleep over consecutive days can lead to abnormal findings in autonomic nervous system assessments.
I recommend that you visit a neurology clinic for further evaluation and follow-up.
Please ensure to practice self-protection, maintain cleanliness and disinfection, and adhere to new preventive measures before and after your medical visits.
Thank you for your inquiry.
If you have further questions, feel free to discuss them!
Wishing you good health and peace,
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2021/08/03

More Info

Chronic neck pain and dizziness can be complex issues that often intertwine, leading to a challenging experience for patients. Based on your description, it seems that you have been dealing with persistent neck stiffness, headaches, and episodes of dizziness for several years. Let's break down the potential causes and considerations from a neurology perspective.

1. Neck Pain and Headaches: Your symptoms of neck stiffness leading to headaches, particularly around the temples and forehead, suggest a possible tension-type headache or cervicogenic headache. These types of headaches often arise from muscle tension in the neck and shoulders, which can be exacerbated by poor posture, stress, or prolonged periods of inactivity. The sensation of a "tight rope" around your head is a common description among those experiencing tension headaches.
2. Dizziness: The dizziness you describe, particularly when lying down or changing positions, could be related to several factors. It may be vestibular in nature, meaning it could involve the inner ear, or it could be related to cervical spine issues. The fact that you do not experience tinnitus (ear ringing) or nausea suggests that it may not be related to inner ear problems, but rather to neck issues or even anxiety.
3. Neurological Findings: The abnormal EEG finding you mentioned, specifically the theta wave activity, could indicate some level of cortical dysfunction, which might contribute to your symptoms. However, it is essential to interpret these findings in the context of your overall clinical picture. The degenerative changes noted in your cervical spine, such as bone spurs, can lead to nerve compression, which may also contribute to both neck pain and dizziness.

4. Autonomic Nervous System: You mentioned the possibility of autonomic nervous system dysregulation. This can manifest as dizziness, particularly when changing positions (orthostatic hypotension), and can be exacerbated by anxiety or stress. Chronic pain conditions can also lead to heightened sympathetic nervous system activity, which may contribute to feelings of dizziness and discomfort.

5. Sleep Quality: Poor sleep quality can significantly impact both pain perception and dizziness. If you are not getting restorative sleep, it can lead to increased muscle tension and exacerbate headaches and dizziness. It might be worthwhile to evaluate your sleep hygiene and consider whether any underlying sleep disorders could be contributing to your symptoms.

6. Cardiovascular Considerations: Your heart evaluations appear normal, which is reassuring. However, if you experience palpitations or a racing heart, it might be worth exploring further with a cardiologist, especially if these symptoms coincide with your episodes of dizziness.

7. Management Strategies: Given the multifaceted nature of your symptoms, a multidisciplinary approach may be beneficial. This could include physical therapy focusing on neck and shoulder muscle relaxation, cognitive behavioral therapy for anxiety management, and possibly medication to help with pain and anxiety. Additionally, lifestyle modifications such as regular exercise, ergonomic adjustments at work, and stress management techniques could also be helpful.

In conclusion, your symptoms of chronic neck pain and dizziness are likely interconnected and may stem from a combination of musculoskeletal, neurological, and psychological factors. It is crucial to continue working with healthcare professionals, including neurologists, physical therapists, and possibly psychologists, to develop a comprehensive treatment plan tailored to your needs. Regular follow-ups and open communication with your healthcare team will be essential in managing your condition effectively.

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