A chiropractic adjustment, or spinal manipulation, uses controlled force on a spinal joint to restore motion and improve function, typically performed on the neck (cervical spine) or back. Vertigo is a sensation of spinning or whirling, often caused by issues in the inner ear or brain. The potential for an adjustment to unintentionally trigger vertigo is a common concern, even though the practice is often used to treat certain types of dizziness.
The Direct Answer: Is the Link Real?
The link between a chiropractic adjustment and vertigo is recognized, but the risk of a severe adverse event is very low. Mild, temporary dizziness immediately following a cervical adjustment is a common and transient side effect. This lightheadedness usually resolves within a few hours as the body adapts to changes in joint mechanics.
The concern for true, prolonged vertigo or a serious complication is statistically rare. Serious adverse events, such as a vertebral artery dissection leading to a stroke, are estimated to occur in a range from one in 10,000 to one in two million adjustments. While the possibility exists, it is not a routine outcome of spinal manipulation.
Anatomical Mechanisms Linking Adjustments to Vertigo
A chiropractic adjustment can potentially cause vertigo through two distinct biological pathways: one common and transient, and one rare and serious.
Benign Paroxysmal Positional Vertigo (BPPV)
The most frequent mechanism involves the inner ear and BPPV. This condition is caused by the dislodgement of otoconia, which are tiny calcium carbonate crystals found in the inner ear’s utricle. A rapid neck movement during an adjustment can cause these crystals to migrate into one of the semicircular canals. Once in the canal, the crystals disrupt fluid movement, sending false signals to the brain about head position and resulting in brief, intense spinning sensations. This type of vertigo is often treatable with specific repositioning maneuvers.
Cervicogenic Dizziness
Another common pathway is related to the neck’s own sensory input, called cervicogenic dizziness. The neck’s upper joints contain sensory receptors that feed information about head position to the brain. When a cervical adjustment alters these signals, the brain may receive conflicting information from the eyes and the inner ear, leading to temporary unsteadiness or dizziness. This sensory mismatch is short-lived as the nervous system quickly recalibrates.
Vertebral Artery Dissection (VAD)
The most serious, though extremely rare, mechanism involves the vertebral arteries, which supply blood to the brainstem and cerebellum. High-velocity manipulation of the neck carries a theoretical risk of causing a tear in the inner lining of the artery, known as VAD. This tear can lead to a blood clot that may travel to the brain, potentially causing a stroke. Individuals with pre-existing vascular conditions are most susceptible to this complication.
Recognizing Vertigo Symptoms After Adjustment
Patients must distinguish between mild post-adjustment dizziness and symptoms suggesting a more serious issue. Mild, transient dizziness or lightheadedness, which might last a few hours, is usually a temporary physiological response to the manipulation. This mild sensation often occurs due to changes in muscle tension or minor blood pressure shifts. If symptoms are mild and lessen over time, rest and hydration are typically recommended.
Certain symptoms are considered red flags and require immediate medical attention, as they may indicate a vascular event like a stroke. These serious signs include true, severe spinning vertigo that is persistent and does not resolve quickly. Other concerning symptoms are the sudden onset of the “worst headache of your life,” slurred speech, double vision, difficulty swallowing, or sudden weakness in an arm or leg. The presence of these neurological symptoms warrants an immediate visit to an emergency department.
Patient Safety and Risk Screening
Reputable chiropractic practice involves a thorough risk screening process to identify patients predisposed to complications. Practitioners take a detailed patient history, specifically asking about previous episodes of vertigo, dizziness, or head and neck trauma, such as whiplash injuries. The history also includes questions about symptoms that could indicate underlying vascular issues, such as severe, unusual headaches or recent infections.
Screening procedures before an adjustment may involve positional testing, like the Dix-Hallpike maneuver, to evaluate for BPPV, or checking the patient’s range of motion and stability. Patients must fully disclose all relevant medical information, including history of migraines, high blood pressure, or known connective tissue disorders that could affect blood vessels. Providing this information allows the chiropractor to tailor the treatment plan, potentially opting for lower-force techniques or avoiding high-velocity neck adjustments entirely.