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“The Chiropractic Stroke” Part Two

“The Chiropractic Stroke”  Part Two

In the last blog, we talked about the article in the January edition of Dynamic Chiropractic discussing chiropractic and potential causations with vertebrobasilar artery dissection. Even among the experts the jury is still out whether or not a manual cervical adjustment can cause the actually tearing of the artery leading to the stroke or not. I was thinking, why not do some more review on the whole phenomena and make sure that as chiropractors we are prepared for a VAD presentation.


First things first…what would be a reason or two a patient with an impending VAD show up in the chiropractors office?  Oh you're going to love this, head and neck pain. I know, one of the bread and butters of the chiropractic profession head and neck pain and it happens to have a very dark side. According to PubMed aka the US government, they found that the headache pain was always located on the same side as the artery or in the posterior neck or have no symptoms at all! Are you kidding me right now?! No symptoms before the artery tears?!!! However, I continued my search through the literature and found some more keys to this mysterious and morose subject.


More often than not, a patient presenting in our offices would be complaining of a headache.  It’s possible to confuse it with a tension or migraine headache, however it appears in most cases there will be some other distinguishable symptoms.

  1. Sever, sharp, sudden onset of pain. With any headaches, that is a question that is supposed to be ask routinely anyways. Severe, sudden, coming out of nowhere pain (anywhere in the body) is a red flag.
  2. The severe, miserable out of nowhere headache almost always has neurological symptoms. Same side face pain/numbness, hoarseness, contralateral loss of pain and temperature sensation in the upper body and limbs.
  3. Hiccups, vertigo, nausea and vomiting
  4. Any potential signs of having a stroke like trouble walking, speaking, comprehension, numbness, paralysis, droopy face, slurred speech, etc.


Now for some more caveats.  VAD is more common in the younger folks (50 years old or younger).  Let’s say you have a new patient who is young and is complaining of migraine like symptoms.  Depending on the age of the patient, this could in fact be their first migraine.  The key here is, to do a thorough exam and history.  The likelihood is, is that it is a just a headache which chiropractors are very good at treating. 


Having certain diseases can also lead to an increase chance in VAD.  Connective tissue disorders like Marfan’s, Ehlers-Danlos, rheumatoid arthritis, sickle sell disease, Down’s syndrome and neurofibromatosis all have a higher likelihood of vascular insufficiency.


According to the top result on google vertebral artery dissection occurs after physical trauma to the neck. Blunt force trauma, car accidents, sudden neck movements (which they lovingly put chiropractic under) and even coughing. 


Painting the picture of a patient with a VAD lying in wait

  1. Under 50
  2. Certain diseases (see above)
  3. Recent blunt force trauma
  4. Severe-sudden, worst headache ever (only on one side)
  5. Stroke like symptoms


With reviewing the signs, symptoms and reasons for VAD along with our vigilance we should continue to feel that chiropractic is safe and effective.  If by chance a patient shows up in your office and you even have the tiniest iota of suspicion that a VAD or stroke is coming on, likely or in the process call 911 immediately and DO NOT ADJUST THEM!

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Kassandra Schultz DC