Execution
- 1Position the patient sitting on a swivel chair or stool with the feet supported.
- 2Stabilize the patient's head in space while rotating the trunk and chair underneath the head.
- 3Ask whether dizziness, disequilibrium, nausea, or familiar symptoms are provoked while the vestibular organs remain relatively still.
- 4Then rotate the head on a stationary trunk to load both the neck and vestibular system.
- 5Compare symptom provocation between trunk-under-head rotation and head-on-trunk rotation.
Positive outcome
Symptoms during trunk rotation under a stable head suggest a cervical contribution because cervical afferents are loaded while the labyrinth is not moved through space. Symptoms only when the head moves in space suggest vestibular contribution. Symptoms in both conditions require broader vestibular, vascular, and neurological screening.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Reid & Rivett (2005) | systematic review of cervicogenic dizziness management | NA | NA | NA | NA |
| Li et al. (2022) | narrative review | NA | NA | NA | NA |
CommentHead-neck differentiation is a clinical reasoning test rather than a validated diagnostic-accuracy test. It helps separate cervical afferent loading from vestibular head-in-space loading. Positive findings should trigger a full cervicogenic dizziness differential, not immediate attribution to the neck.
Low Clinical Value