If you live with craniocervical instability (CCI) or upper cervical instability, you know a very specific kind of exhaustion: the heavy, "bobble-head" feeling, the headaches at the base of your skull, the brain fog and dizziness that ease when you finally lie down.
You may have spent years being told your neck imaging looks normal, that it's migraines, that it's anxiety - while the ground keeps shifting under you.
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At Neuroveda Health, we take upper cervical instability seriously, and we understand where it comes from. For most people it isn't an isolated neck problem - it's one thread in a connective tissue story that also involves hypermobility, dysautonomia, and mast cell activation. We connect those dots, evaluate you honestly, and build a non-surgical plan around the whole picture.
Seattle clinic with telehealth options for Washington State. We're an integrative, non-surgical clinic, and we coordinate closely with neurosurgery and radiology when advanced imaging or a surgical opinion is needed.
What is craniocervical instability (CCI)?
Craniocervical instability (CCI) is excessive or abnormal movement where the skull meets the top of the spine - the craniocervical junction - that can let the bones shift enough to strain or irritate the brainstem, upper spinal cord, nerves, and blood vessels passing through that area. It happens when the strong ligaments that normally hold the head steady on the neck become stretched, lax, or injured, so the muscles are left doing a job the ligaments can no longer do on their own.
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"Upper cervical instability" is the broader term for looseness in the top two joints of the neck. CCI refers specifically to the joint between the skull (occiput) and the first vertebra (C1). Atlantoaxial instability (AAI) refers to the joint just below it, between C1 and C2, which handles most of your head-turning. These often occur together, share many symptoms, and are shaped by the same key ligaments - the transverse and alar ligaments that anchor the head to the spine.
Common signs craniocervical & upper cervical instability
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A heavy head or "bobble-head" feeling, like your neck can't quite hold your head up
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Headaches and pressure at the base of the skull (occipital and suboccipital)
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Neck pain, clicking, clunking, or grinding with movement
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Symptoms that get worse when you're upright and ease when you lie down
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Brain fog, dizziness, vertigo, or a sense of unsteadiness
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Visual disturbances, light sensitivity, or ringing in the ears (tinnitus)
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Racing heart, lightheadedness, and temperature swings (overlapping with POTS)
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Difficulty swallowing, a lump-in-the-throat sensation, or voice changes
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Facial pain, jaw pain, or numbness and tingling in the face or limbs
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Symptoms that shift with the position of your head and neck
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Some symptoms deserve prompt, in-person evaluation - new or worsening weakness, changes in bowel or bladder control, trouble swallowing, fainting, or a rapid neurological decline. If you're experiencing those, tell us right away so we can prioritize the right workup.
Upper cervical instability rarely travels alone.
We treat the whole cluster.
The reason CCI so often shows up alongside other hard-to-treat conditions comes down to one thing: connective tissue. When the collagen that builds your ligaments is more elastic and fragile than it should be, the stabilizing ligaments of the upper neck stretch more easily - and so do ligaments, blood vessels, and membranes throughout the rest of the body. That shared root is exactly the kind of complexity Neuroveda Health was built to untangle.
Hypermobility and Ehlers-Danlos (hEDS/HSD) - hypermobile EDS and hypermobility spectrum disorder are the most common underlying reasons for non-traumatic upper cervical instability. Not everyone with hypermobility develops CCI, but the same lax connective tissue meaningfully raises the risk.
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MCAS (mast cell activation syndrome) - the third member of the hypermobility-dysautonomia-MCAS cluster; systemic inflammation can amplify pain and symptom burden.
Tethered cord syndrome - another connective-tissue-linked condition we commonly see alongside upper cervical instability, contributing to back pain, leg symptoms, and bladder changes.
Dysautonomia and POTS - autonomic symptoms overlap heavily with CCI, and strain at the craniocervical junction sits close to the brainstem centers that help regulate heart rate and blood pressure. We offer complete in-office autonomic nervous system testing - one of only three locations in Washington State with the full four-test evaluation.
Spinal CSF leaks - the same connective tissue fragility can weaken the dura, and a leak can cause upright-worse headaches that look a lot like CCI, so distinguishing the two matters. Dr. Cardenas has a particular focus here.
Chiari malformation and cervical medullary syndrome - low-lying cerebellar tonsils and the broader collection of brainstem and upper-cord symptoms can overlap with, mimic, or compound CCI. Sorting out what's actually driving your symptoms is part of the work.
Most clinics hand each of these to a different specialist. We build one coordinated plan that treats the cluster as what it is: one connected story.
How we evaluate craniocervical & upper cervical instability
Upper cervical instability is one of the most over- and under-diagnosed conditions we see, and both extremes cause harm. Imaging measurements can look abnormal in people with no symptoms at all, and they can look reassuring in someone who is genuinely struggling. That's why a careful diagnosis is never about numbers alone - it's about whether the imaging matches your symptoms and your neurological exam. We'll tell you honestly what we find.
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Our evaluation starts the way all care at Neuroveda starts: with a real conversation about your whole history, your symptom pattern, and what makes things better or worse. Then we layer in the right testing and imaging.
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Focused clinical and neurological exam - mapping position-dependent symptoms and checking for signs of brainstem, cranial nerve, or spinal cord involvement that would change the plan
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Positional and dynamic imaging - the most useful studies capture the neck in the positions that provoke symptoms, such as upright (weight-bearing) MRI and flexion-extension views, with CT for bony detail and rotational CT when atlantoaxial rotary instability is suspected. We coordinate these referrals and help you interpret the results
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Radiographic measurements in context - clinicians use specific measurements of the craniocervical junction (such as the clivo-axial angle, Grabb-Oakes, basion-dens and basion-axial intervals, and the atlanto-dens interval) to assess stability, always read alongside your symptoms and exam rather than in isolation
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Autonomic nervous system (ANS) testing - tilt table, heart rate deep breathing, Valsalva, and QSART - to diagnose the POTS and dysautonomia that so often ride along with instability
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Targeted workup for the cluster - evaluation for MCAS, connective tissue disorders, CSF leak, and related conditions, drawn from our full specialty testing menu
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You don't need to arrive with a diagnosis, a stack of images, or a theory. That's our job - together.
Non-surgical, integrative treatment for upper cervical instability
For most people with non-emergency upper cervical instability, conservative care is the right place to start - and it's where we focus.
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Surgery (occipitocervical fusion) is a real option for patients with clear, demonstrated compression of the brainstem or spinal cord, but it's irreversible and permanently limits neck motion, which is exactly why it's worth doing everything reasonable first.
Our goal is to stabilize, calm, and support your neck and the whole system around it. Every plan is personalized, and we're honest about what's well-established versus still emerging.
Stabilize:
regenerative options for lax ligaments
When the ligaments holding your head steady have stretched, regenerative injection therapy aims to prompt your body's own repair response to strengthen and tighten connective tissue.
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Prolotherapy and Platelet Rich Plasma (PRP) - injected at ligament and tendon attachments to stimulate collagen repair, with the goal of improving passive stability in the cervical spine. Some patients pursue these to try to avoid or delay surgery. We'll be straight with you: for the upper cervical spine specifically, the evidence is still preliminary rather than proven, so we treat these as rationale-based options to consider carefully, not guaranteed fixes
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Perineural Injection Therapy (PIT) and related regenerative tools - to calm chronically irritated nerves and support the surrounding tissue
This work is led by Dr. Carley Squires, ND, LAc, who specializes in hypermobility spectrum disorders, craniocervical instability, and regenerative injection therapy.
Release:
gentle, hands-on care built for fragile necks
Fascial Counterstrain is a gentle, non-forceful manual therapy that releases protective tension in fascia, nerves, vessels, and organs - without the aggressive, high-velocity manipulation that hypermobile necks can't safely tolerate. A word on that: forceful "cracking" or thrust adjustments of an already-loose upper neck can make instability worse, so any hands-on work here should be done gently and only by providers who understand hypermobility. Ours do.
Support: strengthening, posture, and protecting your neck
Because lax ligaments leave your muscles doing the stabilizing, day-to-day support matters as much as any single treatment. We guide you on neuromuscular strengthening of the deep neck stabilizers, posture and ergonomic changes, activity modification for high-strain tasks, and the smart use of a supportive collar during flares or travel - used for rest and relief, not as a permanent crutch that lets the muscles weaken.
Regulate:
calming a nervous system stuck on high alert
Living in a body that doesn't feel stable keeps the nervous system braced and reactive, which amplifies pain, dizziness, and dysautonomia. Quieting that response is central to feeling better.
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Acupuncture & Chinese herbal medicine for pain, sleep, and system-wide balance
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Safe and Sound Protocol (SSP) - a non-invasive auditory intervention that improves vagal tone, emotional regulation, and resilience
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Treating the comorbid POTS and MCAS that drive a large share of the total symptom load, so the whole system settles
Restore:
rebuilding the foundation
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Ayurvedic consultation and treatments - personalized diet, lifestyle, and cleansing therapies matched to your constitution
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IV therapy for hydration and nutrient support - especially valuable when POTS is part of the picture
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Hyperbaric oxygen therapy (HBOT) to support tissue repair and recovery
Care from people who truly get it.
Upper cervical instability care at Neuroveda is provided by a team that treats it every day - and understands how frightening it is to feel like your own head isn't stable.
ND, LAc
is a naturopathic physician and acupuncturist specializing in integrative neurology, hypermobility spectrum disorders (HSD/EDS), craniocervical instability (CCI), dysautonomia, and MCAS/immune dysregulation, with advanced training in regenerative medicine and joint injection. Dr. Squires also heads our Therapeutic Plasma Exchange (TPE) program.
DMSc, PA-C, ATC
brings extensive experience in upper cervical instability, spinal fluid leaks, hypermobility and EDS, MCAS, and POTS, alongside pain medicine and Fascial Counterstrain - and as someone who lives with hypermobile EDS herself, her lived experience shapes how our whole program cares for these patients. (Currently not accepting new patients; her expertise informs our team's approach.)
Behind them stands our full integrative team: functional medicine, Ayurveda, Chinese medicine, and integrative neurology. Because complex conditions deserve more than one set of eyes.
When advanced imaging or a surgical opinion is warranted, we coordinate with trusted neurosurgery and radiology partners rather than leaving you to navigate it alone.
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“I am getting better care than I ever had in my 25 years of chronic pain, and I have been able to acquire the necessary testing to figure out my way forward.”
What your first visit looks like
Connect.
Fill out our inquiry form and tell us your story. We'll match you with the right provider and confirm scheduling and pricing up front.
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Deep-dive consultation.
Your initial visit is a real evaluation - your whole history, your symptom pattern, what makes it better or worse, and what imaging or testing will actually help. No 12-minute appointments here.
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A personalized plan.
Every first visit ends with a collaboratively-determined assessment and treatment plan - imaging to pursue, treatments to begin, and a clear path forward. You stay in the driver's seat.
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We see patients in person at our Seattle clinic and via telehealth for Washington State residents. Many patients travel to us for evaluation, then continue much of their care from home.
Frequently asked questions about craniocervical & upper cervical instability
Is craniocervical instability a real condition, and how is it diagnosed?
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Yes. CCI is a recognized condition, well established in people with connective tissue disorders like Ehlers-Danlos syndrome, prior neck trauma, rheumatoid arthritis, or Down syndrome. It's diagnosed by combining position-dependent symptoms and a neurological exam with imaging - typically upright and/or flexion-extension MRI, CT for bony detail, and specific measurements of the craniocervical junction. Because those measurements can be abnormal even in some people without symptoms, an honest diagnosis requires the imaging to match your clinical picture, not numbers alone.
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Can craniocervical instability be treated without surgery?
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For many people, yes - and non-surgical care is usually the right place to start. Conservative treatment focuses on strengthening the deep neck-stabilizing muscles, posture and activity modification, gentle hands-on therapies suited to hypermobile necks, selective use of a supportive collar during flares, regenerative options for lax ligaments, and treating related conditions like POTS. Surgery (fusion) is generally reserved for people with clear signs of brainstem or spinal cord compression that don't respond to conservative care.
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What's the difference between CCI and atlantoaxial instability (AAI)?
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Both are forms of upper cervical instability, just at different joints. CCI is instability where the skull meets the spine (the occiput-C1 joint). AAI is instability of the C1-C2 joint just below it, the joint that handles most of your head-turning. They frequently occur together and share many symptoms, but they involve different joints and different stabilizing ligaments, which can matter for evaluation and treatment.
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Does hypermobility or EDS cause craniocervical instability?
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Hypermobile EDS and hypermobility spectrum disorder are the most common underlying reasons for non-traumatic upper cervical instability, because the same lax connective tissue that makes joints hypermobile also makes the stabilizing ligaments of the upper neck more prone to stretching. Not everyone with hypermobility develops CCI, but it raises the risk, which is part of why CCI clusters with POTS, MCAS, and related conditions.
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Can prolotherapy or PRP help cervical instability?
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Prolotherapy and PRP aim to stimulate your body to repair and tighten lax neck ligaments, and some patients report benefit and use them to try to avoid surgery. For the upper cervical spine specifically, the scientific evidence is still limited - mostly small studies and case reports rather than large trials - so we consider them promising but unproven, and we talk through whether they make sense for you individually rather than promising a cure.
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Is it safe to have my neck adjusted or manipulated if I have CCI?
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Forceful, high-velocity manipulation (the kind of "cracking" or thrust adjustments common in some chiropractic care) is generally discouraged when the upper neck is already unstable, because it can worsen instability or cause injury. Gentle, non-forceful approaches like Fascial Counterstrain can be helpful and better tolerated. The key is working only with providers who understand hypermobility and upper cervical instability.
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Do you perform surgery or fusion?
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No - Neuroveda is a non-surgical, integrative clinic. We focus on thorough evaluation and conservative, whole-body care, and when advanced imaging or a surgical opinion is warranted, we coordinate with neurosurgery and radiology partners. Many patients want a knowledgeable team to help them exhaust non-surgical options first and to help them make sense of a surgical recommendation if they receive one.
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Do you offer telehealth for CCI care?
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Yes. We're licensed to treat patients located in Washington State, with telehealth available pending provider availability. In-office services like autonomic testing, regenerative injections, and Fascial Counterstrain take place at our Seattle clinic, and many patients combine periodic in-person visits with telehealth follow-up.
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Will insurance cover my care?
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Neuroveda is a direct-pay clinic; we provide Superbills and billing codes so you can seek reimbursement from your insurer. Some components, like imaging ordered through outside facilities, are frequently billed through insurance directly. We keep pricing transparent so you can plan ahead; provider rates are listed on each provider's page.
You deserve care that connects the dots
You've spent enough time holding your own head up and being told your neck looks fine. Whether you're newly suspicious that upper cervical instability explains the heaviness, the headaches, and the fog, or you've been chasing a diagnosis for years and need a team that can treat the whole cluster - we're here for all of it. We're here for you.