Feeling Cold Without a Fever? The Neck May Be Sending a Signal

by Son PMR(Physical medicine & Rehabilitation ) & Chiropractic Clinic in Seoul

A 60-year-old male patient recently visited our clinic, complaining of persistent cold sensations throughout his body—despite having a normal body temperature and no signs of fever. He had undergone general medical evaluations elsewhere, which showed no major abnormalities. Upon our examination, we observed muscular tightness and possible misalignment in the upper cervical spine (C1–C3), which may be contributing to his symptoms.

This case raises an important clinical consideration:
Can upper cervical dysfunction cause a sensation of internal coldness?
The answer is—yes, in some cases.

The Link Between the Upper Cervical Spine and the Autonomic Nervous System

The upper cervical region (C1 to C3) is more than just the top of the spine—it plays a crucial role in regulating autonomic nervous system activity, especially the sympathetic nervous system through its proximity to the brainstem (particularly the medulla oblongata).

When there is dysfunction or imbalance in this region, it may lead to:

  • Heightened sympathetic activity

  • Constriction of peripheral blood vessels

  • Reduced skin blood flow and temperature

These mechanisms may result in subjective coldness, cold extremities, or an overall feeling of being chilled, even without environmental triggers.

Anatomical Insight: The Role of the C2 Nerve

The Greater Occipital Nerve, which originates from the C2 spinal level, supplies sensation to the back of the scalp and has connections to sympathetic pathways. Dysfunction or irritation of this nerve may not only lead to sensory disturbances, but also changes in local thermal perception or abnormal cold sensations.

Supporting Evidence from Research

Several studies support the neurophysiological connection between cervical spine alignment and autonomic nervous function:

  • Kawasaki et al., 2012: Found that misalignment in the upper cervical region can increase sympathetic tone and reduce peripheral circulation.

  • Uthaikhup et al., 2011: Reported that cervical dysfunction influences somato-autonomic reflexes, which affect temperature regulation.

  • Ernst, 2004: Reviewed case reports in which spinal manual therapy led to changes in autonomic function and improved peripheral circulation.

Other Conditions to Rule Out

Of course, not all cold sensations originate from the cervical spine. A thorough clinical assessment is required to rule out conditions such as:

  • Hypothyroidism

  • Anemia

  • Diabetic or peripheral neuropathy

  • Autonomic dysfunction

  • Psychogenic factors such as anxiety or chronic stress

What’s Next?

In this case, we are currently conducting further evaluation to determine whether the patient’s cold sensations are indeed related to his upper cervical dysfunction. If confirmed, conservative upper cervical care—including manual therapy, myofascial release, and postural correction—may be helpful in relieving symptoms.

Note: This post is for educational purposes only and does not substitute for professional medical advice. Each patient should receive individualized evaluation and care based on a qualified healthcare provider's clinical judgment.

👍Consultation and Appointment Information

Son PMR & Chiropractic Clinic( 2nd floor, 229-1 Gucheonmyun-Ro, Gangdongu, Seoul, South Korea) 

by  Dr Son MD & DC 
Contact: 02-482-8875 in Seoul( +82-2-482-8875)


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