The Neurology Behind Dizziness and Vertigo
A client of mine asked recently, “What causes dizziness and vertigo?” Specifically, this client asked about the cause of Meniere’s “Disease” (which is not a disease at all, but a syndrome characterized by dizziness/vertigo, ringing in the ears, and transient hearing loss).
If you’ve read any of my other articles about Meniere’s Syndrome, BPPV, Cervicogenic Vertigo, Labyrinthitis, Vestibular Neuritis, and so forth, then you know that I don’t really care what the diagnosed name is. What I care about is what is causing the dizziness/vertigo, and more importantly, what can we do about it! The wiring of the brain may be key in understanding the cause of dizziness and vertigo. There can be multiple potential causes of dizziness and vertigo.
In my professional opinion, I believe that the most common cause is a disruption of the nerve network that controls and coordinates balance information. This type of information is called “proprioception,” and it is sometimes called your “6th Sense.” Proprioception is the relay of sensory information to your brain about where your body is in space.
In order to stand upright, your brain must receive and process a huge volume of proprioceptive information every send. If not, one of the immediate consequences can be dizziness or vertigo. Think of this network as a computer processing information.
If the computer is processing too much information, or if your computer has something like a virus that is corrupting its ability to process the information, it's going to freeze or crash. Similarly, if something disrupts your proprioceptive network, the likely consequence is dizziness or vertigo!
The thing about it is that it usually isn’t a virus that causes the issue. If you experience dizziness or vertigo, you’ve probably already had a series of MRIs where your ENT was looking for some type of tumor or infection affecting your inner ear.
And when they couldn’t find anything, they concluded that the problem was either a virus or something to do with “crystals moving in your inner ear.” The thing about it is that you can’t actually see these crystals or a virus either! When it comes to dizziness or vertigo, it is rarely something like a virus or tumor causing the process. It is far more likely that the problem is a proprioceptive processing error!
And that is important to realize because it opens the door to a number of potential solutions that go way beyond simply looking at your inner ear!
The Parts of the Brain involved with Dizziness and Vertigo
What are the major players in processing proprioceptive, balance, and coordination information? This section may be for the more technical-minded people, and you can skip ahead to the next section if you want.
The brief version is that the majority of proprioceptive information is processed through a massive network of nerve hubs and electrical conduits that criss-cross between several structures in your brainstem at the junction between your head and neck. Attempting to keep a very complex topic simple, let’s look at some of those major players.
- Cerebellum. The major, and single-most-important supercomputer that processes all balance and coordination information between your brain and body. Your cerebellum sends and receives signals directly from every other group of nerves that I’m going to mention!
- Vestibular Nuclei. A cluster of multiple groups of nerves, they are what process the balance information that comes from your inner ear. So even if your inner ear organ is working just fine, if these vestibular nuclei do not process that information correctly, you can experience the exact same symptoms!
- Superior & Inferior Colliculus. In conjunction with a huge number of additional centers in the upper part of your brainstem, these nerve cells coordinate reflexes between your inner ear, your eyes, your cerebellum, and also surprisingly your neck (as I will discuss shortly)!. If these signals are not coordinated properly, it is impossible for you to stand upright without feeling like spinning out.
So these are the major balance-processing centers in your brain. However, there is still the other half of the equation, which are the actual nerve receptors that convey proprioceptive information to these centers.
The Nerve Receptors involved with Dizziness and Vertigo
I’ve already alluded to the first one, which is the vestibular apparatus (aka inner ear organ) … but would it surprise you to learn that your jaw joint and your neck are equally important in maintaining balance?
Your neck and jaw contain a ridiculously dense number of nerve receptors, which far outnumber the number of proprioceptors found almost anywhere else in the body. (The only two areas that may rival the jaw and upper neck would be the pelvis and the ankles).
To put things into perspective, the muscles that support your C1 and C2 vertebrae at the base of your skull contain a certain type of proprioceptor (called a muscle spindle) that is 100-200x denser than other muscles in your spine. When it comes to understanding what causes dizziness and vertigo, Meniere's syndrome, and other balance disorders, the problem may not involve the inner ear but may involve the neck and the way it ties into the neural circuits of the brain.
Mechanically, the joints in your upper neck (C0-C1-C2) are also extremely complex, allowing for 50% of the total movement in your neck. Even the joints through your lower neck (C3-C7) are far more flexible than the joints through the rest of your spine.
Ultimately, this means that they provide more proprioceptive information to your brain so that things stay in proper balance and motion. Alas, the flip-side is that injuries to your neck may lead to dizziness and vertigo or other balance disorders including Meniere’s Syndrome.
Dr. Michael Burcon is an Upper Cervical Specific chiropractor and researcher from Michigan (USA), and he has identified from his work with over 300 patients experiencing Meniere’s Syndrome with a 97% success rate is that a common underlying feature of people who experience vertigo is a 15-year old whiplash-type injury that damages the joints in your upper neck plus the discs and proprioceptors in your lower neck.
What he has found, along with many other upper cervical chiropractors worldwide is that by correcting these types of imbalances and by restoring the normal alignment of the joints in the neck that people who suffer dizziness and vertigo may be able to achieve remarkable relief for conditions that many people still call “incurable.”
- Kulkarni V, Chandy MJ, Babu KS. A quantitative study of muscle spindles in the suboccipital muscles of human foetuses. Neurol Indfa, 2001;49(4):355-9.
- Armstrong BS, McNair PJ, Williams M. Head and neck position sense in whiplash patients and healthy individuals and the effect of the cranio-cervical flexion action. Clin Biomech (Bristol, Avon). 2005 Aug;20(7):675-84.
- Burcon MT. Health Outcomes Following Cervical Specific Protocol in 300 Patients with Meniere’s Followed Over Six Years. Journal of Upper Cervical Chiropractic Research ~ June 2, 2016 ~ Pages 13-23.