How is Cervical Vertigo Diagnosed?

Diagnosis is generally uncertain and frustrating. First, other entities need to be ruled ou,t including inner ear disease, central vertigo, psychogenic vertigo (often including malingering when there are legal issues), and medical causes of vertigo. There should be no hearing symptoms or findings, but there may be ear pain (otalgia), as part of the ear is supplied by sensory afferents from the high cervical nerve roots. As cervical vertigo often follows a head injury; in this situation, the various causes of post-traumatic vertigo shoud be considered.
If cervical vertigo still seems likely after excluding reasonable alternatives, one next needs to look for positive confirmation. The "gold standard test" for the vertebral arteries is vertebral angiography. Because this is a risky procedure by itself, often it is decided not to proceed to this step. Ordinary magnetic resonance angiography (MRA) and vertebral doppler procedures are rarely abnormal, and sometimes are used as a screening procedure to decide whether vertebral angiography is necessary. A magnetic resonance imaging (MRI) scan of the neck and flexion-extension X-ray films of the neck are suggested in all.
Many patients who have vertigo in the context of neck disease have a BPPV type nystagmus on positional testing. This suggests that the neck afferents may interact strongly with vestibular inputs derived from the posterior canal.