This is the story of a man in his late 30s experiencing panic attacks, blood pressure surges, and other concerning symptoms. In this case, he was able to experience a decrease, and then stabilization of these symptoms with cervical focused chiropractic care. Care that may have positively affected his Vagus Nerve.
This mini case history may help someone with similar challenges find help in an unexpected way.
Wearable devices help diagnose man’s panic attacks
Panic attacks often feel like heart attacks. That’s what my patient first thought was happening as he felt his anxiety building and spiking.
Because he uses a wearable device that monitors his heart rate and heart rate variability, his diagnosis came back as panic attacks rather than heart attack. He also wore a cardiac monitoring device that measured his heart rhythms to be sure that his heart wasn’t the issue.
The good news was there was no involvement of his heart. The bad news was he didn’t know what driving his growing sense of anxiety into full blow panic attacks, including surges in blood pressure.
He also experienced disequilibrium, or unsteadiness, which could create spinning sensations. He wondered was there a connection between the vertigo-like symptoms and his panic attacks?
What are panic attacks?
Panic attack is a sudden episode of intense fear or discomfort that comes on quickly, often within minutes. It can feel overwhelming and may occur unexpectedly or in response to a stressful situation.
Common symptoms of panic attacks
- Rapid heartbeat (palpitations)
- Temporary rise in heart rate and blood pressure due to the body’s “fight or flight” response
- Shortness of breath or a choking sensation
- Sweating, trembling, or shaking
- Chest pain or tightness
- Dizziness, lightheaded, or feeling faint
- Numbness or tingling
- Chills or hot flashes
- Feeling detached from reality
- Fear of losing control, going crazy, or dying
How panic attacks are different from general anxiety?
It’s possible to have both general anxiety and panic attacks together, but here are the differences between the two.
Onset and intensity: Panic attacks are sudden and extremely intense, while general anxiety builds gradually and is usually less overwhelming.
Duration: Panic attacks typically peak within 10 minutes and resolve within 20–30 minutes. General anxiety can persist for hours or even
days.
Physical changes: Panic attacks often produce a sharp spike in heartrate and blood pressure, along with strong physical symptoms that may feel like a heart problem. General anxiety usually causes more moderate, ongoing physical tension without dramatic spikes.
Focus: General anxiety tends to center on ongoing worries or stressors, while panic attacks may occur without warning.
Can anxiety and even panic attacks be related to the neck?
Yes, anxiety and panic attacks can be related to the neck. More on that below. Right now, here is how I worked with this patient to begin to address the problems in his neck and posture.
Posture and spine exams show stress to the upper and lower neck
This patient showed significant but common distortions to his upright posture.
- His right leg appeared to be 1.5″ shorter on his right side laying face up and face down. This is a strong sign of potential pelvic distortion.
- His pelvis, thorax, lower neck, and head sat to the right of a central gravity line, and his right knee showed a lot of external rotation.
- His head and neck balanced to the right of the mid-line with significant right head tilt.
- X-rays of his neck showed asymmetries in alignment (not just from the shape or size of the bones), and the view of his neck from the side showed an extension lock at his C3 vertebra with a slight reverse cervical curve in his upper neck.
- X-rays of his pelvis showed a sacral unleveling and drop in the right pelvis.
These structural distortions happened at the same time that the left neck from shoulder to the base of the skull was extremely tight and sore to the touch. While he didn’t experience much spinal pain, we did have occasions of right knee pain.
My assessment of his spine and posture and panic attacks
I was happy to see that there was a lot of postural distortion and signs of structural stress in his neck. With a lot of distortion comes the potential for a lot of improvement. Since there was no immediate threat to his heart, we had time to see if unlocking the neck might result in a decrease in his symptoms.
Clearly his neck and upper back were suffering from asymmetrical tension. Anecdotal evidence by some chiropractic groups show a link between anxiety and similar symptoms to reverse cervical curve in the upper neck.
How I adjusted his spine, and the chiropractic techniques used
You can read about a summary of my process regarding upper cervical chiropractic care and my perspective on posture here. This is a very brief description of the path I took with this patient.
- X-rays showed the appearance of upper neck misalignment, which was adjusted via instrument in a side-posture position.
- Posture was released via the QSM3 technique, with particular focus on the C3 extension.
- When I found that his posture continued to shift back the right with more frequently than I hoped, I began to incorporate pelvic blocking and holds from Sacro-Occiptial Technique (SOT), which helped stabilize the posture further.
- After several weeks his symptoms changed for the better, and after several months they became stable.
- We took an x-ray to verify a shift in the C3 extension about 8 months after his first x-ray.
- I have stayed in contact with this patient since 2022, seeing him for maintenance visits a few times per year. So far his improvements have stayed stable.
The patient’s experience in his own words
I asked the patient in this story to write up his version of the experience. This is what he provided me:
Before seeing Dr Ward, I was having frequent panic attacks. My heart rate and blood pressure would spike, accompanied by an overwhelming feeling of anxiety. I felt like I was going to die.
I also suffered from intermittent vertigo.
During my initial visit Dr Ward took photos and X-rays and asked a lot questions.
He spent a lot of time trying to understand my exact symptoms.
In subsequent visits, he explained that I have an s-shaped curve in my neck and that straightening it out would help alleviate my panic attacks.
After a few months I was panic attack free with episodes gradually becoming less frequent. Initially, I had multiple episodes daily.
During my treatment he also helped with my knee pain and straightened out my legs – one was shorter than the other, a condition I thought I was born with. I sleep better and don’t wake up with headaches. I now see Dr Ward on a “as needed” basis.
Are neck alignments a solution for all panic attacks?
Neck alignments felt like a “cure” to this patient to the symptoms of his panic attack. That is not a word I’d use, despite his positive outcome. His panic attack improvements make sense, and there are good reasons why they might improve. However, if the origin of his panic attacks were not in structural stress to his nervous system, then his panic attack symptoms may have persisted.
Since we don’t know the origin for all panic attacks, we can’t say that we have a cure. What we do have is a correction to an underlying stress that may affect many persons with panic attacks.
Is the Vagus Nerve responsible for the potential relationship between the neck and panic attacks
Now more than ever people are becoming aware of the relationship between the Vagus Nerve (Parasympathetic Nervous System) and the body’s sense of well being.
Interference to the Vagus system from neck stress or misalignment?
Since the main controller of the parasympathetic nerve system leaves the skull near the start of the upper neck, its hypothosized that bony or fascial stress to the nerve can down-regulate the Vagus, creating stress symptoms.
How the Vagus affects how we feel
Your body has an “automatic” system called the autonomic nervous system that controls things like heart rate, breathing, and digestion. The Vagus Nerve is a big part of this system and helps your body shift between stress and calm.
When in “fight or flight” mode our system will ramp up our heart rate, blood pressure, and breathing in preparation for danger.
The Vagus helps us shift out of our “fight or flight” response when the danger is over. An irritated or down-regulated Vagus may allow us to shift into danger mode or panic attack sensations without any real danger present.
This is one hypothesis on how Vagal stress from structural problems in the neck may contribute to anxiety and panic attack symptoms.
The connection between vertigo or disequilibrium and anxiety and/or panic attacks?
The patient in this story also reported sensations that felt like vertigo to him in and time-period leading up the panic attacks. Upper cervical chiropractors often work with patients with vertigo, so one wonders if there may be link between panic attacks and vertigo.
In fact, the connection between vertigo with anxiety and panic attacks is deep enough that it deserves its own post, which we will publish in the future.
What about neck alignment and general anxiety?
General anxiety isn’t just a milder form of panic attack. Not everyone with general anxiety has panic attacks, and many cases of general anxiety have known triggers, where panic attacks often have no trigger at all. So we can’t assume that neck alignments will help general anxiety in the same way.
However, if the theory about Vagus Nerve down-regulation is accurate, some persons with general anxiety disorder may find a decrease in symptoms. Especially if the source of stress is in the neck.
Seeking help for panic attacks?
If you’re seeking help or more information about panic attacks and neck alignment, feel free to reach out to our office.
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