No Increased Risk of Cervical Artery Dissection Following Cervical Manipulation

The researchers nevertheless conclude that clinicians should remain vigilant for symptoms that may indicate an existing dissection. The study was published in Chiropractic & Manual Therapies.

One of the Largest Studies to Date

The association between cervical spinal manipulation and cervical artery dissection has been debated for decades. Cervical artery dissection is a rare but serious condition that can lead to ischemic stroke. At the same time, neck pain and headache are among the most common presenting symptoms of an existing dissection, making it difficult to determine whether manipulation is a causal factor or simply occurs because patients seek care for early symptoms of the condition.

In the new study, researchers analysed U.S. healthcare claims and insurance data collected between 2010 and 2025. They compared 431,492 patients who received cervical spinal manipulation from a chiropractor with an equal number of matched patients who were prescribed ibuprofen for new-onset neck pain or headache.

Fewer Dissections in the Manipulation Group

Within 30 days of treatment, 31 cases of cervical artery dissection were identified in the manipulation group, compared with 58 cases in the control group. This corresponds to 7.2 and 13.4 cases per 100,000 patients, respectively. The researchers therefore found no increased risk of cervical artery dissection following chiropractic cervical manipulation.

The study also found:

• No increased overall risk of cervical artery dissection following cervical spinal manipulation.
• A lower incidence of carotid artery dissection in the manipulation group.
• No statistically significant difference in the risk of vertebral artery dissection between the groups.

Although fewer cases of cervical artery dissection were observed among patients receiving cervical manipulation, the researchers caution that this difference may be explained by residual confounding. In other words, unmeasured differences between the patient groups may have influenced the results rather than reflecting a true protective effect of the treatment.

What Does This Mean for Chiropractors?

The study adds important evidence to an area where previous research has produced conflicting findings. According to the authors, the results support the theory that the association between cervical manipulation and dissection reported in some earlier studies may be attributable to patients with an already existing dissection seeking care for neck pain or headache before the condition is diagnosed.

For chiropractors, the findings provide a large and contemporary dataset that can inform discussions about patient safety. The study does not support the hypothesis that cervical spinal manipulation increases the risk of cervical artery dissection.

Continued Clinical Vigilance Remains Essential

The researchers emphasize that chiropractors should continue to be alert to symptoms and clinical findings that may indicate an underlying cervical artery dissection. CeAD may initially present with neck pain or headache, often before neurological symptoms develop.

The authors therefore stress the importance of ongoing attention to differential diagnosis, including sudden-onset or unusual pain, recent trauma, infection, or neurological deficits. They also call for further research in specific higher-risk populations, including patients with migraine, connective tissue disorders, or pregnancy.

Trager, R.J., Baumann, A.N., Labak, C.M. et al. Association between spinal manipulative therapy and cervical artery dissection in patients with neck pain or headache: a retrospective cohort study. Chiropr Man Therap 2026.