Neck pain is among the most common reasons patients visit a doctor’s office. In nearly all cases, neck pain is not a sign of a potentially life-threatening issue and can improve over time with appropriate care, such as manual therapies provided by a doctor of chiropractic. However, there are some conditions in which neck pain is a symptom that require more intensive treatment to reduce the risk for severe disability or death. One such condition is called cervical artery dissection (CAD).

The cervical artery is one of the main arteries that deliver oxygen-rich blood to the head. If the lining of the artery tears or is compromised in some capacity, it can result in a set of symptoms including new-onset, severe headache or migraine; pain or tenderness on one side of the neck; pain in the face; pulsating tinnitus; paralysis on one side of the body; change or loss of vision; and a painful, drooping eyelid. While it appears most cases may resolve on their own, CAD can lead to ischemic stroke, which can be life-threating. Interestingly, while the name implies CAD is the result of traumatic event, a 2018 article published in the journal Stroke noted that the majority of CAD cases are spontaneous and not the result of mechanical trauma. The authors add that most cases of CAD occur in patients with a connective tissue disorder that may be genetic and can be influenced by environmental factors, adding that CAD tends to occur in a seasonal pattern in line with some infectious diseases.

Because patients with CAD may visit a doctor of chiropractic for treatment of concurrent neck pain or headaches and then subsequently have a stroke, there was a false belief in the past that neck adjustments may cause CAD. Several studies have looked at this and found the risk of stroke following a chiropractic visit for neck pain is similar to the risk following consultation with a medical doctor for the same complaint; that is, a cervical adjustment is not likely a cause of stroke. In a March 2023 study, researchers used ultrasound to measure blood flow in both the carotid and vertebral arteries in patients with chronic non-specific neck pain before and after receiving spinal manipulative therapy and concluded that this form of treatment did not alter blood flow parameters in either artery.

The potential for CAD highlights the importance of patients providing a full case history when seeking care and letting their treating doctor know of any new symptoms since their last visit. This paperwork, as tedious as it may be to complete, may alert your healthcare provider that a more serious issue may be present so appropriate care can be rendered.