Chiropractic care is a widely recognized alternative therapy focusing on the relationship between the body’s structure, primarily the spine, and its overall function. Many individuals seek chiropractic adjustments for back and neck pain, headaches, and to enhance overall well-being. This non-invasive approach aims to restore proper spinal alignment, alleviate nerve pressure, and improve mobility.
Understanding Vertebral Artery Dissection and Stroke
A vertebral artery dissection (VAD) occurs when a tear forms in the inner lining of a vertebral artery in the neck, which supplies blood to the brain. Blood can then enter the arterial wall, forming a clot. This clot can thicken the artery wall, impeding blood flow or break off and travel to the brain, blocking blood supply and causing an ischemic stroke.
VAD can happen due to various everyday activities or spontaneously. Common non-chiropractic causes include sudden head movements, intense coughing or sneezing, minor neck trauma, or activities like wrestling, yoga, or prolonged neck hyperextension. Underlying conditions like connective tissue disorders (e.g., Ehlers-Danlos or Marfan syndromes) can also increase susceptibility. While VAD is a rare cause of stroke in the general population, it accounts for a higher percentage of strokes in individuals younger than 45.
Connecting Chiropractic Care and Stroke Risk
Cervical (neck) spinal manipulation has been associated with vertebral artery dissection, a rare but serious potential complication. The mechanism involves manipulation potentially stretching or damaging the vertebral artery, particularly in the upper cervical spine, which can lead to a tear in the artery lining. This damage can initiate the formation of a blood clot that may then travel to the brain, resulting in a stroke.
The precise incidence of VAD caused by chiropractic neck manipulation is difficult to definitively prove. Some studies suggest a statistical association between cervical manipulation and VAD, but definitive causation is still debated within the scientific community. Patients experiencing neck pain or headache, common reasons for seeking chiropractic care, might already have an undiagnosed VAD, leading to a “chicken or the egg” phenomenon where the symptoms prompt the visit.
If a VAD is related to manipulation, symptoms typically manifest immediately or within minutes to a few hours following the adjustment. However, symptoms can sometimes emerge later, with reports of onset occurring up to a few days or even weeks after the manipulation. This delayed onset can make it challenging to directly link the event to a specific chiropractic session.
Recognizing Potential Stroke Symptoms
Recognizing stroke symptoms is time-sensitive. These symptoms often appear suddenly. A severe, abrupt headache, sometimes described as the “worst headache of life,” can be a prominent indicator, often accompanied by neck pain that feels different from typical muscle soreness.
Other symptoms include dizziness or vertigo, which is a sensation of spinning or imbalance, often with nausea or vomiting. Visual disturbances such as double vision, blurred vision, or partial loss of vision can also occur. Difficulty speaking (slurred speech), trouble swallowing, or numbness and weakness on one side of the body are additional signs that demand immediate attention. The mnemonic BE FAST (Balance, Eyes, Face, Arms, Speech, Time) can help in identifying these symptoms.
Prioritizing Patient Safety
Patient safety in chiropractic care involves several important measures. Before any manipulation, particularly of the neck, a thorough patient history and physical examination are essential to identify any pre-existing risk factors for VAD. This includes discussing any history of connective tissue disorders, recent trauma, or unusual neck pain.
Patients should openly discuss their complete medical history and any concerns they have with their chiropractor. Informed consent is a professional and legal standard, ensuring that patients understand the proposed treatment, its potential benefits, and any known risks, including the rare possibility of VAD.
Should any concerning symptoms such as severe headache, dizziness, vision changes, or weakness develop immediately or even days after a chiropractic adjustment, it is imperative to seek emergency medical attention without delay. Prompt evaluation by medical professionals is crucial, as early diagnosis and treatment can significantly improve outcomes in cases of stroke.