This is a summarized text to our 2026 published research: Brain-based symptoms reported in young adults evaluated for cervical spine etiology: a retrospective, cross-sectional clinical study with preliminary data on over 200 patients.

Hauser RA, Griffiths M, Watterson A, Matias D, Steilen C and Rawlings BR (2026) Brain-based symptoms reported in young adults evaluated for cervical spine etiology: a retrospective, cross-sectional clinical study with preliminary data on over 200 patients. Front. Neurol. 17:1749266. [Google Scholar]

Physical and mental symptoms caused by changes in brain function.

Background: Brain-based symptoms are physical or mental symptoms caused by changes in brain function. These symptoms, including brain fog, headaches, anxiety, and trouble concentrating, are becoming more common. While factors like stress, inflammation, and prolonged electronic device use may contribute to the severity of these symptoms, what causes them in the first place remains a mystery. Our study looked at whether problems in the cervical spine could be involved in causing these “mystery symptoms.”

This study reviewed the records of 227 patients seen from January to June 2022 who reported symptoms such as brain fog, headaches, trouble concentrating, anxiety, depression, panic attacks, rumination, or obsessive thoughts.

The connection to cervical spine instability was revealed as:

• 100% of patients had forward head posture,
• 90% had a reduced neck curve,
• and 87% had instability in the upper neck (C1–C2).

In “Neck Vitals” testing, we found most patients also showed reduced vagus nerve and internal jugular vein size, along with enlarged optic nerve sheath diameters. We believe that problems with the cervical spine can affect the brain in two main ways: (1) by pressing on the internal jugular veins, which can reduce the flow of blood and cerebrospinal fluid (CSF) from the brain, causing higher pressure inside the skull, and (2) by damaging or interfering with the vagus nerve, which can lead to issues with the body’s automatic functions, such as changes in blood flow to the brain, increased stress, unstable moods, and inflammation. Both of these problems can cause various symptoms in the brain, either alone or together.

Since people in this group did not have known causes of neck injuries, but still had neck problems, we hypothesized that spending a lot of time with your head down or pushed forward—like when using phones or computers—might be causing these neck issues.

Stress on the cervical spine

Spending hours each day looking down at phones or leaning forward at computer screens is something our bodies have only recently started to deal with, especially in the last 15–20 years. This is likely why we are seeing new postural problems, even in teenagers. Some conditions are being named after these habits, like “text neck” and “computer vision syndrome.” It’s possible that poor posture and changes in the neck’s structure are causing brain-related symptoms in younger people, but this hasn’t been fully studied yet.

Objective test findings in patients with chronic eye symptoms seeking care at an outpatient neck center: ligamentous cervical instability etiology?

Since people in this group did not have known causes like neck injuries, but still had neck problems, we think that spending a lot of time with your head down or pushed forward—like when using phones or computers—might be causing these neck issues.

Spending hours every day looking down at phones or leaning into computer screens is a new 21st century. Because technology has been part of daily life for 15–20 years, we are now seeing changes in posture even in teenagers. New problems like “text neck” and “computer vision syndrome” have appeared.

Smart phone usage is associated with neck pain, and using a smartphone in the facedown cervical flexion position doubles the likelihood of experiencing severe symptoms. Excessive electronic device (smartphone and computer) use has been strongly associated with an influx of brain-based symptoms and leading to a breakdown of the cervical lordotic curve, a condition known as “cervical dysstructure.”

Cervical Dysstructure – Cervicovagopathy

As the neck is the superhighway through which everything that goes into and out of the brain has to traverse, we speculate that significant cervical spine changes can adversely affect optimal brain functioning.

Eight main symptoms in 227 patients

Of the 227 patients seen at Caring Medical Florida between January 1 and June 30, 2022, we found the 8 main symptoms were:

• 205/227 had brain fog (90%)
• 202/227 had difficulty concentrating (89%)
• 199/227 had headaches (88%)
• 190/227 had anxiety (84%)
• 167/227 had depression (74%)
• 115/227 had obsessive thoughts (51%)
• 98/227 had panic attacks (43%)
• and 92/227 had rumination (41%).

Neck pain was reported by 211/227 (93%) of patients. Overwhelmingly, 95% of patients who reported at least 1 of the 8 symptoms reported 3 or more of the 8 symptoms.

To qualify for the study, patients had to:

1. Be between 20 and 50 years old
2. Have no known explanation for their symptoms
3. Have symptoms lasting longer than 6 months
4. Report at least one of the eight symptoms on their intake questionnaire

Patients were excluded if they:

1. Already had a known diagnosis or identifiable cause for the symptoms
2. Had a history of significant head or neck trauma that could explain the symptoms

Neck Vitals Diagnostic Testing

Neck vitals are a series of diagnostic testing used to asses and evaluate patient symptoms. The results may offer an understanding of how these symptoms may relate to and be caused by cervical spine instability.

• Vagus Nerve Ultrasonography
  • The vagus nerve can be measured with ultrasound as it travels through the neck alongside the carotid artery. In this study, ultrasound was used to measure the vagus nerve’s cross-sectional area (CSA). Because the vagus nerve helps regulate the body’s parasympathetic (“rest-and-digest”) system, measuring its size may help identify autonomic nervous system imbalances in patients with unexplained brain-based or systemic symptoms.
    In healthy adults, the vagus nerve typically has a CSA of about 1.9–2.5 mm², with the right side often slightly larger than the left. In this patient group, however, the average CSA was significantly smaller—1.33 mm² on the right and 1.37 mm² on the left.
    Because cervical spine-related problems often affect both sides of the neck equally, the researchers evaluated the combined CSA of both vagus nerves. Using a cutoff of less than 4.2 mm² as abnormal, they found that 95% of patients had reduced total vagus nerve CSA, suggesting possible vagus nerve atrophy or degeneration.
    Since the vagus nerves travel through the neck directly in front of the cervical spine, they may be vulnerable to stretching or compression from cervical spine abnormalities. The authors suggest that vagus nerve degeneration related to cervical spine dysfunction—sometimes called cervicovagopathy—may contribute to brain-based symptoms in some patients.
• Transcranial and Extracranial Doppler: Testing blood flow into and out of the brain to identify certain head and neck positions that may be restricting flow and causing the symptoms.
• Pupillometry & Optic Nerve Evaluation
  • Pupillometry measures how the pupils respond to light and can help show changes in nervous system activity. It has been used in serious conditions such as sudden increases in intracranial pressure after trauma or brain surgery. It can also suggest increased sympathetic nervous system activity.In this group of patients with brain-based symptoms, 95% had a high pupillary light constriction response, with an average bilateral constriction of 74.4%, compared with a normal range of 30–60%. Also, 91% had relatively large pupils, with an average combined pupil diameter of 10.22 mm, compared with a normal bilateral range of 4–8 mm.Although a high bilateral constriction response may not always be abnormal, the combination of large baseline pupil size and strong light response suggests that the pupils were functioning properly, but the patients may have been in a sympathetic-dominant, or “fight-or-flight,” state.
• Intraocular Pressure
  • Tonometry, a test that measures eye pressure (intraocular pressure), is included in the neck vitals evaluation because increased intracranial pressure can affect the eyes. Elevated intracranial pressure may cause changes such as flattening of the back of the eye, altered fluid drainage, and increased eye pressure. The connection between neck veins and eye pressure is well known. For example, simply wearing a tight necktie can raise eye pressure by 2–4 mmHg. In about two-thirds of cases, increases in eye pressure are associated with increases in intracranial pressure. Eye fluid normally drains through veins that ultimately empty into the internal jugular veins (IJVs), so impaired venous drainage from the neck may contribute to elevated eye pressure.
  • In our clinical experience, some patients with elevated eye pressure but no primary eye disease experienced reductions in eye pressure after treatment aimed at relieving IJV compression through neck reconstruction therapy.
  • In this study, patients tended to have higher-than-normal eye pressures, averaging 17.8 mmHg per eye (35.6 mmHg combined), compared with a normal range of 10–15 mmHg. Additionally, 19% of patients had combined eye pressures greater than 42 mmHg, a level considered consistent with ocular hypertension.
• Heart Rate Variability and vagus nerve function: We test the fluctuations between heartbeats under various movements, as well as the size of the cross-sectional area of the vagus nerve because the vagus nerve has the greatest impact on heart function and gives a good overview of a person’s autonomic nervous system status.

All qualified patients received dynamic structural imaging and “neck vitals” testing following the standard clinical protocol at our outpatient neck clinic, including upright digital motion x-ray (fluoroscopy, DMX) and upright cone beam computed tomography (CBCT) of the cervical spine, pupillometry, tonometry, and ultrasound of the carotid sheath (internal jugular veins and vagus nerves) and the eye (optic nerve).