The Relationship Between Dizziness and Neck Pain

Study Overview
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Brief Summary
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Both dizziness and neck pain are common complaints in the Norwegian population. The cervical spine has a highly developed proprioceptive system, which is involved in head and gaze stabilization as well as postural control. Thus, it has been argued that dizziness and/or unsteadiness can occur due to loss of or inadequate stimulation of neck receptors in patients with neck pain. Still, the notion of dizziness due to cervical dysfunction is a controversial topic. However, clinicians report that patients referred for dizziness often complain of neck pain, and vice versa. This study is a multi-center study including patients referred to 1) a neuro-otologic clinic due to dizziness and 2) a rehabilitation clinic due to neck pain. Both clinics are tertiary care university clinics. The study explores the prevalence, severity and spectrum of symptoms as well as clinical findings in patients with various combinations of dizziness and neck pain. The aim is to see if these patient groups differ from each other in terms of clinical characteristics, symptoms and quality of life. Additionally, the aim is to examine if there is a relationship between neck dysfunction and dizziness, and last, if the symptoms persist longer in patients with both dizziness and neck pain.

Detailed Description
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This is a longitudinal study with data collected at baseline, 6 months and 3 years follow-up. Variables collected at baseline include age, sex, symptom variables including Dizziness Handicap Inventory, Vertigo Symptom Scale Short Form, Haukeland Dizziness Questionnaire, Visual analog scale, Hospital Anxiety and Depression Scale, RAND-12, dynamic posturography, video-based head impulse test, bithermal caloric tests, Neck Disability Index, as well as neck examinations including pressure algometry and measurements of the range of neck movements. Follow-up data after 6 months include the same patient-reported outcomes as at baseline.

Official Title
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Dizziness and Neck Pain - is There a Relationship and Does it Matter?

Conditions
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Dizziness, Vertigo, Neck Pain

Participation Criteria
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Eligibility Criteria
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Inclusion criteria for patients: Residence within the Health Region of Western Norway AND Referral to the ENT department of Haukeland University Hospital due to vertigo OR Referral to Nordås Outpatient Clinic due to neck pain lasting > 3 months Exclusion criteria for patients: Severe orthopaedic or neurologic disease affecting postural balance Inability to undergo test protocol due to physical or language barriers Quaternary referrals (vestibular schwannomas or divers with vestibular disorders) Inclusion criteria for healthy controls: - Employees at Haukeland University Hospital Exclusion criteria for healthy controls: Known neurologic or vestibular disease or ongoing ear disease. Neck pain within last 3 months

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 67 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Dizziness<br>Patients referred to a neuro-otological clinic due to dizziness who answer that they do not suffer from neck pain | |
| Dizziness and neck pain<br>Patients referred to a neuro-otological clinic due to dizziness who answer that they suffer from neck pain | |
| Neck pain<br>Patients referred to a rehabilitation center due to neck pain who answer that they do not suffer from dizziness | |
| Neck pain and dizziness<br>Patients referred to a rehabilitation center due to neck pain who answer that the suffer from dizziness | |
| Healthy Control<br>Healthy Controls without neck pain or dizziness | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Difference between Groups in the Dizziness Handicap Inventory (DHI) | 25-item symptom score. 0-100 Points on dizziness handicap severity | Baseline and 6 months follow-up | 
| Difference betwee Groups in the Neck Disability Index (NDI) | 10-time symptom score. 0-50 Points on neck disabilty severity | Baseline and 6 months follow-up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlation between Posturography and neck pain | Path length is used as measure of steadiness. Neck pain is measured With a pressure algometer, measuring the pressure pain threshold of the neck in kilo pascal. | Baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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posturography, quality of life, pressure algometry, cervicogenic dizziness