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Headaches

Headaches can have multiple causes some are as dehydration, stress and as a result of illness. Although, headaches can have a cervicogenic origin which means that it is a result of an underlying neck disorder. This can result in referred pain spread across different regions of the head.  The cranial nerve is responsible for innervation to regions of the head and its origin is from the upper cervical spine. The trigeminal nerve innervates regions of the face and its origin is from the lower cervical spine.  Conclusively, among other causes, headache can have a cervical spine cause that can be due to prolonged static postures, muscular disturbance or joint disturbance. These can cause irritation to the nerve supply and result in the headaches.
A thorough examination and specific treatment from a physiotherapist can resolve the symptoms of a cervicogenic headache.  

Dizziness

The origin of dizziness is multifactorial and an experienced practitioner should be examine various causes that could lead to your symptoms. 

The causes on their majority may be attributed to central or peripheral pathologies and may be due to injury, illness or infection, trauma and age-related neurological degeneration. Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo that is due to semicircular-canal pathology in the inner ear. An experienced physiotherapist will be able to assess and help you manage your symptoms of dizziness alongside a multidisciplinary team. 

-BPPV

- Neuronitis

- Vestibular Hypo / Hyper function 

- Multi-sensory causes 

Vertigo

In true vertigo the sensation the person experiences are the illusion of movement of the self around the environment, or vice versa the self around the environment. 

 The most common reasons of a new onset of dizziness are most commonly due to Vestibular Neuritis (approximately 30% of the cases) and refers to the inflammation of the 8th cranial nerve. It usually has a viral cause, and it is managed by medication and vestibular rehabilitation. In some cases of acute onset of dizziness, there will be associated hearing loss on one side. Those cases are probably due to Labyrinthitis or Acoustic Neuroma. These will be managed by an Ear Nose and Throat Consultant (ENT) for medical management and with vestibular therapy.

SERIOUS CAUSE: The main differential in the acute presentation, is to exclude the presence of a stroke (Very uncommon ≈ <5%) which has characteristic signs and symptoms. A specialist doctor and physiotherapist can differentiate the causes of symptoms and guide you through appropriate management. 

Intermittent onset refers to spells of dizziness that come and go on different intervals. The most common pathologies that have an intermittent nature are: 

-BPPV (Benign Paroxysmal Positional Vertigo): (≈50% of all cases) The symptoms are a result of a displaced fragment of "crystals" (otoconia) within the semi-circular canals of the inner ear.  The symptoms are severe spinning of yourself or the environment around you. It is positioning dependent, which means that it gets aggravated by movement of the head or body, such as lying down, rolling in bed, looking upwards, etc. The symptoms can last anywhere between 1-60 seconds. 

The management of BPPV is with particle repositioning maneuvers that are performed by a trained medical or specialist physiotherapist, that usually have a miraculous quick resolution of symptoms. It can also be managed with home exercises and vestibular therapy. 

-Meniere's Disease: It is a long term, degenerative disease affecting the balance organs and inner ears. The attacks, unlike BPPV, last for hours and present with hearing loss. Symptoms tend to get aggravated salty diets. The management is multifaceted, and it includes a combination of medications, dietary changes and vestibular therapy during the periods of relapse. 

-Migraine-Associated Vertigo: Very similar presentation of long-lasting symptoms (hours) but without hearing loss. The triggers tend to be stress and anxiety and in those with a history of migraines. This is managed with stress and anxiety relaxation techniques, dietary changes, vestibular rehabilitation and anti-migraine medications. 

Chronic presentation:

The chronic presentation refers to the symptoms of dizziness that are constant and daily and can be mainly divided into two groups: 

- Cerebellar Ataxia: It is a central problem in the brain that has a gradual onset with age. Commonly this is associated with a history of alcohol abuse and presents with poor muscle control that causes clumsy voluntary movements. This is managed by a multi-disciplinary team and should be guided by a neurologist. 

- Non-compensated Peripheral Vestibular Dysfunction: This category includes large number of patients who have had a previous peripheral pathology, such as vestibular neuritis, Meniere's disease, etc., who have never fully recovered. In this category, there is no visible pathology, and it is most commonly mislabeled as psychological. This causes an unnecessary, lengthy and very demoralizing journey, since these patients are not seen soon enough by trained vestibular therapist and feel alone and unsupported. 

For these individuals, vestibular rehabilitation is really effective and causes compensations centrally from the brain that restores the normal equilibrium between vestibular stimuli and therefore decreases the symptoms.