Trajectories of neck pain and dizziness-related disability: insights from a three-year prospective longitudinal cohort study

Abstract Background The bidirectional relationship between neck pathology and dizziness has been widely debated in clinical practice and research. We aimed to examine the trajectory of the presence of neck pain in a population with dizziness and investigate the longitudinal relationships among the presence, level of disability, intensity of neck pain, and dizziness-related disability over a three-year period. Methods A longitudinal prospective cohort study was conducted with 237 patients referred for suspected vestibular disorders to an ear-nose-throat (ENT) clinic (mean age 46.0). Data, including the Dizziness Handicap Inventory (DHI), neck pain intensity and neck disability index (NDI), were collected at baseline, 6 months, and 3 years. Mixed-effects linear regression models were used to assess the association between neck pain and dizziness-related disability over time. Results At baseline, 58.0% of the participants reported neck pain, 72.7% of whom continued to experience neck pain after three years. The presence of neck pain at baseline significantly predicted increased DHI scores after 3 years (β: 11.58, 95% CI: 6.09, 17.07; p < 0.001). Among the patients with neck pain, the NDI was the strongest predictor of DHI score (β: 1.18, 95% CI: 0.70–1.67, p < 0.001), whereas neck pain intensity had a weaker association. No significant interactions were observed between neck pain features and time, indicating a stable relationship between these symptoms over the study period. Conclusions Neck pain is highly prevalent and persistent in patients with dizziness referred to an ENT clinic and is strongly associated with greater dizziness-related disability. Assessment of neck-related disability using the NDI provides additional predictive value for symptom burden. These findings highlight the importance of addressing neck pain in the management of dizziness to improve patient outcomes.