TABLE 2.

Symptoms suggestive of musculoskeletal or neurological upper cervical instability.

	Common	Highly suggestive
Musculoskeletal UCI
● Heavy/bobble head, patient feels like they need to support or brace their head to decrease symptoms		X
● Apprehension about initiation or maintenance of neck movement or travel in vehicle		X
● Lump in throat, trouble swallowing		X
● Consistent clicking or clunking in the neck associated with neck movement		X
● Cervical sensorimotor symptoms such as tinnitus, dizziness		X
● Suboccipital headaches	X
● Yoke/coat-hanger distribution pain	X
● Neck tension, muscle spasm	X
● Brain fog	X
● Inconsistent or poor response to treatment for the neck	X
● Sleep disturbance, snoring, sleep apnea	X
Neurological UCI
● Report of seizure-like activity, diagnosis of “non-epileptic seizures” or “pseudo seizures”		X
● Drop attacks not associated with dysautonomia (e.g., provoked by neck motion, or without dizziness common in POTS)		X
● Lump in throat, choking, trouble swallowing, voice changes		X
● Symptoms of dysautonomia (especially if not responding to standard treatment), persistent anxiety, functional GI dysfunction, poor temperature regulation, heat intolerance, presyncope,	X	X
● “Boat rocking” instability (not due to musculoskeletal issues)		X
● Ataxia: Poor coordination (not due to joint instability)		X
● Facial tingling/numbness		X
● Pulling sensation in face, head, teeth, tongue (muscle contraction, not just pain)		X
● Vision changes-trouble with convergence, double vision, aura (teichopsia)		X
● Dystonia: Involuntary muscle contractions causing involuntary movements or postures		X
● Intermittent dysesthesias in the limbs, not associated with local issues		X
● Sleep disturbance, snoring, sleep apnea	X
● Cognitive changes		X