Dizziness
You stand up and the room tilts. Or everything sways slightly, like standing on a boat. Or the dizziness comes every time you turn your head. You may have already seen an ENT specialist, your GP and a neurologist. Perhaps BPPV was diagnosed, or a splint was recommended, or nothing conclusive was found.
Dizziness affects more than 20% of all adults in any given year and is, after headaches, the most commonly reported neurological symptom (Chaibi & Tuchin, J Chiropr Med, 2011, PMC3259942). And one of the most frequently overlooked causes is not in the ear — it is in the cervical spine.
At our chiropractic practice in Munich-Bogenhausen, we examine and treat dizziness of musculoskeletal origin — jaw, cervical spine, thoracic spine, pelvis. No referral needed. Same-week appointments available.
What is cervicogenic dizziness — and why is it so often missed?
Cervicogenic dizziness is dizziness caused by dysfunction in the cervical spine. Not the inner ear. Not blood pressure. Not a virus. The cervical spine.
The mechanism: the upper cervical spine contains a dense concentration of mechanoreceptors and proprioceptors — sensors that continuously transmit information to the brain about the position and movement of the head in space. This information is matched in the brainstem with signals from the vestibular organ of the inner ear and the visual system.
When joints in the upper cervical spine (particularly C0–C3) are restricted, tense musculature sends faulty signals, or proprioception is disturbed after a whiplash injury, a mismatch occurs. The brain receives conflicting information — and interprets it as dizziness.
The tricky part: cervicogenic dizziness mimics other forms of dizziness. It can feel like positional vertigo. It can cause nausea. It can occur alongside tinnitus. And because it produces no clean diagnosis from a standard investigation, it ends up in the "cause unclear" folder.
De Vestel et al. demonstrated in a 2022 systematic review and meta-analysis that manual therapy in cervicogenic dizziness significantly improves dizziness intensity, pain, cervical range of motion and balance — compared to sham treatment, no treatment and other physiotherapeutic approaches (J Man Manip Ther, 2022, PMID 35383538, PMC9487935).
What types of dizziness are there — and which are relevant for chiropractic care?
Cervicogenic dizziness — dizziness from the cervical spine
As described above. Typical pattern: dizziness combined with neck pain or tension, triggered or worsened by head movements, stronger in the morning on waking, frequently accompanied by headaches.
Directly relevant for chiropractic treatment.
Dizziness from muscle tension
A subtype of cervicogenic dizziness. Chronically tense suboccipital musculature — the short neck extensors directly beneath the skull — can continuously send faulty proprioceptive signals. Patients often report a diffuse sense of dizziness in the head, haziness, or the feeling of not being quite clear-headed. Frequently occurs alongside stress-related dizziness.
Directly relevant for chiropractic treatment.
Stress-related dizziness
Stress increases muscle tone — particularly in the neck and shoulder musculature. Chronic stress leads to persistently elevated tension in the suboccipital region, which in turn disturbs cervical proprioception. This is not psychosomatic — it has a concrete mechanical cause that is triggered and maintained by stress.
Relevant for chiropractic treatment — in combination with stress management.
Dizziness and nausea
Dizziness accompanied by nausea is frequently interpreted as a sign of vestibular disease. That is sometimes correct — but nausea is also a common accompanying symptom of cervicogenic dizziness. The vagus nerve, which mediates the nausea response, can be influenced by tension in the upper cervical spine and the craniocervical junction. When nausea consistently occurs together with head or neck pain, an examination of the cervical spine is worthwhile.
Relevant for chiropractic treatment when a cervical cause is identified.
Dizziness when standing up
The classic dizzy feeling when standing up quickly is, in most cases, orthostatic hypotension — a brief blood pressure drop that self-regulates within seconds. This is not a chiropractic matter. However, if dizziness on standing persists longer, is associated with neck pain, or is triggered by slow positional changes, a cervical component may be present.
Partially relevant — after exclusion of cardiovascular causes.
Dizziness when lying down — including in bed
Dizziness even when lying down or during positional changes in bed is classic for BPPV (benign paroxysmal positional vertigo) — caused by crystals (otoliths) in the inner ear that have become displaced into a semicircular canal. The Epley manoeuvre performed by the ENT specialist is the treatment of choice with a high success rate.
What many patients do not know: BPPV and cervical dysfunction frequently co-exist. Anyone who has had the Epley manoeuvre successfully performed but still has residual symptoms or neck pain will often benefit from chiropractic co-management of the cervical spine.
Co-management appropriate after ENT treatment.
Dizziness with tinnitus
The simultaneous presence of dizziness and tinnitus leads many patients to suspect Menière's disease. That is possible — but tinnitus and dizziness can also occur together when the upper cervical spine or temporomandibular joint is dysfunctional. Both structures lie in direct proximity to the middle ear and can influence auditory perception.
Frequently relevant in HWS syndrome and TMD — chiropractic treatment can help.
BPPV — benign paroxysmal positional vertigo
Triggered by displaced otoliths in the inner ear. The first point of contact is always the ENT specialist for the Epley manoeuvre. When residual symptoms persist or neck pain is simultaneously present, we treat the cervical component as a complement.
Primary: ENT — chiropractic as co-management.
Menière's disease
Menière's is an inner ear condition with episodic vertigo, hearing loss and tinnitus. Chiropractic does not treat the endolymphatic hydrops that underlies Menière's. What we can treat: the frequently co-existing cervical and temporomandibular dysfunctions, which can amplify symptoms or influence the frequency of episodes.
Not primary — complementary co-management appropriate.
Dizziness after a cold or flu
One of the most common questions we hear: "I was ill, the dizziness has stayed — what is this?"
When a viral infection affects the vestibular nerve (vestibular neuritis), dizziness can persist for weeks or months after the illness. This is an ENT and neurological indication.
What we treat: the musculoskeletal consequences of a period of illness. Anyone who has been bedridden has tense, shortened muscles and restricted joints. The upper cervical spine suffers particularly from immobility. A feeling of blockage or pressure in the ears — common in the recovery phase after upper respiratory infections — can also be positively influenced through adjustments in the jaw and upper cervical region.
We do not treat active infections. Once the patient is no longer infectious, is free of fever and the illness has resolved, chiropractic treatment is appropriate — to restore function after enforced inactivity.
Relevant in the recovery phase.
Dizziness with high blood pressure
Dizziness as an accompanying symptom of hypertension is a medical matter — not a chiropractic indication. When dizziness occurs in the context of known hypertension, the first priority is medical management of blood pressure. Only when blood pressure is stable and dizziness persists does it make sense to investigate cervical contributing factors.
Red flags — when to seek immediate medical attention
Dizziness is usually benign, but there are constellations that require immediate medical assessment — not a chiropractic appointment:
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Sudden severe vertigo combined with double vision, swallowing difficulties, speech disturbance or gait disorder → exclude stroke, call emergency services
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Dizziness after head or neck trauma → exclude fracture or vascular injury
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Dizziness with severe headache ("worst headache of my life") → subarachnoid haemorrhage, immediately to emergency department
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Dizziness combined with facial numbness, drooping corner of the mouth or arm weakness → stroke
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Dizziness with known brain tumour or unclear neurological history → neurology first
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Dizziness with cardiac arrhythmia, chest pain or loss of consciousness → immediate cardiovascular assessment
In these cases, immediate medical assessment is required — not a chiropractic appointment.
What to do about dizziness — immediately
What can help in the short term
Calm, controlled movements — no abrupt standing up. When rising from lying: first roll to the side, then slowly sit up, then stand. Warmth on the neck musculature reduces tension that causes proprioceptive disturbances. Fresh air and a stable visual focal point help to ground the balance system.
What does not help
Avoidance of movement — anyone who stops moving entirely because of dizziness amplifies the muscle tension and proprioceptive disturbances that are causing the dizziness. This is a vicious cycle. Dizziness from the cervical spine gets worse with immobility, not better.
Betahistine and pain medication treat the symptom, not the cause — useful short-term, not a treatment plan long-term.
What almost nobody does — but should
Have the cervical spine examined when all other causes have been excluded. Cervicogenic dizziness is a diagnosis of exclusion — but it should be actively made, not simply forgotten.
What causes cervicogenic dizziness?
The proprioception of the cervical spine — an underestimated system
The upper cervical spine is the proprioceptively richest region in the entire musculoskeletal system. Per gram of muscle tissue, the suboccipital musculature contains more muscle spindles than almost any other muscle group in the body. These spindles deliver second-by-second information to the brain about head position.
When these signals are distorted by restrictions, muscle tension, degenerative changes, or post-traumatic disturbances (after whiplash), a sensory conflict arises. The vestibular system, visual system and cervical proprioception deliver contradictory information — the brain interprets this as dizziness, haziness or balance disturbance.
Cervical spine syndrome and dizziness
Cervical spine syndrome — a collective term for symptoms originating from the cervical spine — is one of the most common causes of cervicogenic dizziness. Restricted segments at C1/C2/C3, tension in the suboccipital musculature and an altered head posture (forward head posture) combine to produce a pattern that causes dizziness, headaches and neck pain simultaneously.
Whiplash and post-traumatic dizziness
Cervicogenic dizziness following whiplash accounts for a substantial proportion of cases. Trauma damages the mechanoreceptors and joint capsules of the upper cervical spine, which can result in permanently disturbed proprioception — even years after the accident when all imaging results are unremarkable.
The connection to the jaw
The temporomandibular joint and the upper cervical spine share neuroanatomical connections via the trigeminocervical complex. TMD patients show significantly more frequent balance disturbances and dizziness — and dizziness patients often have an untreated TMD simultaneously. Both structures are always examined at our practice.
How does a chiropractor in Munich treat dizziness?
What does the research say?
De Vestel et al., J Man Manip Ther, 2022 (PMID 35383538) — Systematic review and meta-analysis: manual therapy in cervicogenic dizziness significantly improves dizziness intensity, pain, cervical range of motion, head repositioning accuracy and sagittal alignment. Evidence quality: low to moderate — but consistently positive compared to control conditions.
Chaibi & Tuchin, J Chiropr Med, 2011 (PMC3259942) — Case study: patient with 10-year history of treatment-resistant cervicogenic dizziness. After chiropractic SMT (Gonstead method, atlanto-occipital joint, C7, thoracic spine, sacrum): 86% pain reduction, 99% dizziness reduction, 78% improvement in quality of life.
Strunk & Hawk, J Chiropr Med, 2009 (PMC2786230) — Feasibility study, 19 patients, 8 weeks of chiropractic care: large effect on balance (effect size 1.2). Most patients showed improved balance scores; a proportion showed clinically meaningful improvements in dizziness.
Steward, Cureus, 2025 (PMC11927947) — Narrative review: atlas subluxation complex as an aetiological factor in dizziness; upper cervical chiropractic (NUCCA) shows favourable dizziness outcomes across case reports and case series.
At American Chiropractic Haus, we have a three-pronged approach to dizziness:
Phase 1 — Acute phase: reduce dizziness, restore function
A detailed case history — not just about the dizziness, but the entire musculoskeletal picture. When does dizziness occur? Connection to head movements? Associated neck pain? History of whiplash, illness, TMD? Previous assessments and treatments?
Then the physical examination: cervical range of motion, palpation of the upper cervical spine (C0–C3), suboccipital muscle tension, Romberg test, gait assessment, temporomandibular joint examination. Neurological supplementary tests where needed to aid differentiation.
What we do in this phase:
Chiropractic adjustment of the upper cervical spine. The focus is on segments C0–C3 — the atlanto-occipital junction and the upper cervical segments, which have the greatest influence on cervical proprioception. Precise adjustments of these segments initiate immediate neurophysiological processes: mechanoreceptors are activated, abnormal afferent input normalises.
Soft tissue therapy of the suboccipital musculature. The short neck extensors beneath the skull are frequently massively hypertonic — hard to palpation, painful on pressure. Their release is often the first perceptible step toward dizziness reduction. Myofascial release and trigger point therapy are applied here.
Adjustment of the thoracic spine and pelvis. As with all conditions: the body is a system. Restrictions in the thoracic spine influence shoulder and head posture, which in turn influences suboccipital tension.
Temporomandibular joint assessed alongside. When tinnitus, ear pressure or TMD symptoms are present, the temporomandibular joint is included in the treatment — both manually and with the Activator instrument where appropriate.
In the acute phase, the patient is passive. The body is treated.
Phase 2 — Rehabilitation: retraining balance
When acute dizziness subsides, the stabilisation phase begins.
Neurorehabilitative exercises for balance stabilisation. These exercises specifically train the integration of the vestibular system, visual information and cervical proprioception. Concretely: head-eye coordination exercises, gaze stabilisation, balance exercises on unstable surfaces. These are not generic "balance exercises" — they are calibrated to the specific disturbance pattern of the individual patient.
DNS-based stabilisation of the deep cervical flexors. Forward head posture — the typical postural fault in dizziness patients — is maintained by weakness of the deep cervical flexors. DNS exercises train the neuromuscular control required for a neutral head position and therefore for healthy cervical proprioception.
Graded exposure to movement-triggered dizziness. Many dizziness patients automatically avoid movements that provoke symptoms. This is understandable — but counterproductive. Controlled, gradual exposure to triggering movements desensitises the system and improves the brain's compensatory capacity.
Phase 3 — Prevention: keeping dizziness from returning
After 4–6 treatments — typically once weekly — most patients report a significant reduction in dizziness frequency and intensity. Many are symptom-free. Long-term, the goal is autonomy.
An individual home programme — exercises tailored precisely to what maintains or triggers dizziness in that specific patient.
Postural optimisation in daily life — forward head posture in office workers and smartphone users is a chronic loading factor. Concrete workplace adjustments, targeted corrective exercises.
Preventive check-up appointments every 6–8 weeks. Cervicogenic dizziness tends to recur — particularly during periods of stress, after prolonged immobility or following a new illness. Regular brief check-up visits identify restrictions before they become symptomatic again.
The goal: patients should understand what triggers their dizziness — and be able to prevent it before it returns.
When to see a chiropractor for dizziness?
Come in if:
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Dizziness occurs in combination with neck pain or tension
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Dizziness is triggered or worsened by head movements
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Dizziness is stronger in the morning on waking or after prolonged sitting
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Tinnitus or ear pressure occurs alongside dizziness
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Headaches and dizziness occur simultaneously or alternately
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BPPV has been treated but residual symptoms persist
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Dizziness persists after a cold or flu and the illness has resolved
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Dizziness continues despite unremarkable ENT and neurological investigations
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Stress visibly influences dizziness intensity
When to see a doctor, ENT or neurologist
ENT specialist (HNO): for suspected BPPV (Epley manoeuvre), hearing loss, acute tinnitus or Menière's disease.
Neurologist: for dizziness following stroke, suspected MS, or dizziness with neurological accompanying symptoms (visual disturbance, swallowing difficulties, numbness).
GP: for dizziness with unclear general symptoms, hypertension, or dizziness during active illness.
Frequently asked questions about dizziness
What helps quickly against dizziness?
Controlled movements — no abrupt standing, no sudden head turns. Warmth on the neck relaxes the suboccipital musculature that frequently causes proprioceptive disturbances. Fresh air and a fixed focal point help the balance system to stabilise. Betahistine can reduce symptoms short-term — but does not treat the cause. What genuinely helps: establishing whether the cervical spine is involved, and having it specifically treated.
Can dizziness come from muscle tension?
Yes — this is one of the most common and most overlooked connections. The suboccipital musculature beneath the skull contains an exceptionally high density of muscle spindles. Chronic tension in this area delivers distorted positional information to the brain — and the brain interprets the contradiction as dizziness. Releasing and adjusting this region is often the most direct path to dizziness reduction.
What is the difference between dizziness and vertigo?
Vertigo refers specifically to the subjective sensation of rotational movement — either the surroundings appear to spin, or the body appears to spin. Dizziness is a broader term and includes vertigo, but also haziness, swaying, unsteadiness and the feeling of impending fainting. For treatment purposes, the distinction matters less than the cause: is the dizziness coming from the inner ear, the cervical spine, the circulation or a neurological source?
Which doctor is best for dizziness?
It depends on the type. For acute rotational vertigo, hearing loss or suspected BPPV: the ENT specialist. For dizziness with neurological symptoms: the neurologist. For dizziness combined with neck pain, tension, headaches, or after whiplash: the chiropractor — because the cervical spine is frequently the cause, and this is not systematically assessed in standard ENT or neurological investigations.
When is dizziness dangerous?
Dizziness is rarely an emergency — but the exceptions are serious. Sudden severe vertigo with double vision, swallowing difficulties or gait disturbance can indicate a stroke: call emergency services immediately. Dizziness with the worst headache of your life: emergency department. Dizziness after head trauma without ENT assessment: see a doctor first. When in doubt: assessment before treatment.
How long does it take for cervicogenic dizziness to improve?
Most patients with cervicogenic dizziness notice a perceptible improvement after 2–3 treatments. After a full treatment plan of 4–6 sessions — weekly, then fortnightly — many patients are symptom-free or have transitioned to preventive check-ups. For chronic dizziness following whiplash or a long clinical history, it takes longer and requires more stabilisation work.
Can chiropractic help with dizziness when ENT and neurology have found nothing?
Yes — and this is precisely the constellation we most commonly work with. When all vestibular and neurological causes have been excluded and dizziness persists, the cervical spine is the next systematic step. Cervicogenic dizziness does not appear on a standard MRI or in an ENT examination — it is diagnosed through clinical examination of cervical spine function. That is our domain.
Dizziness after a cold — when to see a chiropractor?
Once you are no longer infectious, fever-free and the acute illness has resolved. Bed rest and inactivity during illness generate muscle tension and joint restrictions that maintain dizziness in the recovery phase. The sooner the body is restored to function during convalescence, the faster balance and spatial orientation normalise.
