Vertigo is the technical name for dizziness, especially the type where it feels like the room, or the patient, is spinning.

Most of us are familiar with this feeling; it often accompanies colds and sinus congestion, and I am told that drinking too much alcohol also can cause it. Another common cause is fluid buildup or infection of the inner ear, because the brain depends on the ear for balance and position input. When the input is disturbed, bad information gets sent to the brain, making you feel dizzy.

But the inner ears are not the only cause of vertigo, because they are not the sole source of balance information to the brain. Another source are the joints and muscles of the neck. It is thought that the inner ear is responsible for motion and position sense about the head itself, and the neck supplies information about the relation between the head and the body. Because the brain relies on both, problems with either can give you vertigo.

The neck structures most likely to cause vertigo are a muscle called the sternocleidomastoid (SCM for short) and the uppermost joints of the spine. According to Dr. Janet Travell, author of “The Trigger Point Manual” (and John F. Kennedy’s physician during his presidency), trigger points in the SCM muscle have been shown to produce all kinds of symptoms, including tearing of the eye, headache, sinus congestion, ear and jaw pain, pain with swallowing and vertigo. The joints of the neck also have strong effects on the whole head region, with similar effects.

These problems are typically overlooked, because most doctors evaluating a dizzy patient only look to the ear, and miss the connection with the neck. Problems can be present without any neck pain. It takes a doctor or therapist who has been trained to look for these mechanical problems to detect them.

A chiropractic neurologist developed an ingenious test to determine if vertigo is coming from the neck. Most doctors assume that if dizziness is worsened by movement of the head, that means it is coming from the inner ear. But most head movements involve moving the neck as well, so this simple “test” does not exclude the neck as a cause. This doctor uses a chair that rotates at the base, and has an assistant hold the patient’s head steady while the doctor rotates the chair left and right. This causes motion at the neck without any head movement. If the patient’s dizziness is made worse during this procedure, the cause has to be in the neck. Of course, no test is perfect; the best way to determine if your vertigo is coming from the neck is to have the neck examined by someone trained in this area.

Most dizzy patients don’t have problems with just the neck or the inner ear; commonly both are affected. For example, mechanical problems in the neck can interfere with lymphatic drainage of the head, leading to inner-ear vertigo.

Also, neck problems can be triggered by an ear infection. This is especially true of the SCM muscle, which courses right along the lymphatic drainage of the head, and can be irritated by the nearby inflammation. Vertigo that persists after the infection has passed is often coming from neck structures that are stuck in an inflamed state.

Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at