Can a neck massage trigger a stroke? Vertebral artery risk zones, dangerous moves, and warning signs for seeking medical care

Every once in a while, there is news about a stroke after a massage or chiropractic adjustment. The comments section below is consistently divided into two camps: one says they are scared to death and don't dare get massaged anymore, while the other says they have been getting massaged for decades and nothing has ever happened.

Both camps are half right. This kind of thing actually exists and is not an urban legend; however, it is indeed rare, so there is no need to avoid massages from now on. What is worth understanding clearly is: why it happens, which movements are dangerous, and what warning signs of trouble to look out for.

Why is the vertebral artery often the one injured?

Because its position is deep yet exposed, and it leads directly to the brain.

There are two sets of blood vessels supplying the brain: the carotid arteries in the front, and the vertebral arteries that run along the cervical spine. The vertebral artery is responsible for blood flow to the brainstem, cerebellum, and back of the brain. After branching off from the subclavian artery, for most people, it enters a series of bony passages formed by the transverse foramina of the cervical vertebrae at the sixth cervical vertebra (C6), runs all the way up, leaves the passage near the first and second cervical vertebrae (C1/2), and turns into the cranium.

This route has two types of weaknesses.
The segment below the passage (roughly between C6/7 and the first thoracic vertebra) has no bone protection and is directly exposed within soft tissues. Meanwhile, the two junctions where the artery enters and leaves the passage (near C5/6 and C1/2) require the blood vessel to bend and have high mobility, making them the most mechanically vulnerable positions. Once the inner lining of the blood vessel is torn by an external force, blood penetrates into the layers of the vessel wall. This is what is known as arterial dissection—the dissection can narrow the lumen or form a blood clot, and if the blood clot is swept into the brain, a stroke occurs.

Which movements carry the highest risk?

The pattern is more important than the strength; there are three recommendations to avoid.

The first is sudden twisting, especially backward bending combined with twisting—the kind of technique where the neck is quickly "cracked." The vertebral artery cannot withstand this kind of sudden pulling at the junctions.
The second is pressing deeply along the course of the blood vessels in the neck: the midline of the back of the neck, both sides of the midline, and the front and sides of the neck are all areas densely packed with blood vessels and nerves. Applying heavy pressure or using instruments directly on these positions carries a high risk.
The third is applying vibrating devices directly to the neck—massage guns are designed to handle large muscles, not the neck. Clinically, there have indeed been cases of temporary cerebral ischemic symptoms, such as suddenly being unable to speak, after using them on the neck.

Conversely, the thick trapezius muscle on top of the shoulders is the source of soreness for most people, and it is also a relatively safe massage area. Most massages do not result in trouble; the incidents are almost always concentrated in the combination of "the wrong area + sudden or excessive force."

If these symptoms appear after a massage, do not treat them as mere soreness

The symptoms of arterial dissection do not necessarily appear on the spot and may be delayed by several hours to several days, which is precisely why it is easily missed.

If any of the following occur within a few days of a massage, chiropractic adjustment, or force applied to the neck, please seek medical attention immediately: sudden and severe headache or neck pain (distinctly different from usual soreness), weakness or numbness on one side of the limbs, slurred speech or inability to speak, double vision or visual field defects, spinning dizziness combined with vomiting, unstable gait, or persistent blacking out of vision. These are manifestations of posterior circulation ischemia. Stroke management is a race against time; if you suspect it, call an ambulance, do not drive yourself.

When seeking medical attention, please proactively inform the staff: "I recently had a neck massage or chiropractic adjustment." This medical history will directly change the direction of the examinations the doctor arranges, saving hours of time.

Another less common type: cerebrospinal fluid leak

Problems caused by external forces are not limited to blood vessels. If the dura mater wrapping the spinal cord is torn and damaged, cerebrospinal fluid leaks out, and intracranial pressure drops, producing a very characteristic headache: it worsens when standing or sitting and is significantly relieved when lying flat. This positional headache is different from ordinary headaches, and if it occurs, it likewise requires medical evaluation. It can be spontaneous, or it may be related to external forces or invasive procedures; its incidence is lower than that of arterial dissection, but it indeed exists in medical literature.

How are these problems diagnosed?

It relies on imaging, specifically imaging of the blood vessels and the spinal canal.

When arterial dissection is suspected, CT angiography (CTA), magnetic resonance angiography (MRA), or catheter angiography is used to look directly at whether there is dissection in the blood vessel wall or narrowing of the lumen—the dissected blood vessel will show an irregular outline on the image, unlike a smooth normal blood vessel. When a cerebrospinal fluid leak is suspected, myelography is used to find the leak point. The interpretation of these two types of examinations is the daily work of imaging specialists, which is why radiologists are often the first to see the answer in the diagnosis of such cases.

So can I still get a massage?

Yes, it is safe under most circumstances, but there are three principles.

Avoid the areas where the blood vessels run in the neck; to treat soreness, just focus on the muscles of the shoulders and upper back. Reject techniques involving sudden twisting or backward bending with twisting; you can say no to any movement that intends to "crack" your neck. Keep vibrating devices off the neck.

Additionally, the academic community is still discussing the causal relationship between massage and dissection—in some cases, the blood vessel may have already begun to dissect and first manifested as neck pain, and the patient went for a massage because of the neck pain, resulting in an overlap in timing. The practical implication of this is: for neck pain of unknown cause, especially when it appears suddenly and is different in nature from the past, find out the cause first before deciding whether to get a massage.

If you suspect your symptoms and wish to have an evaluation in our clinic?

If you currently have any of the warning symptoms listed above, please seek immediate medical attention or call 911 (or local emergency services). Do not book a clinic appointment; time is brain cells.

For non-acute situations—persistent neck discomfort after a massage, mild dizziness that needs checking, or neck pain of unknown cause that you want to investigate thoroughly before handling.
You can describe your condition first via LINE. Preliminary evaluations that Sunrise Medical can perform include medical history organization, structural localization of cervical spine imaging, and ultrasound blood flow evaluation, with assistance in referrals when CTA, MRA, or further management is needed.
Dizziness induced by turning the head is another topic, please see "Dizzy only when turning your head, and fine when looking straight?".
Sunrise Clinic is located at 2F-1, No. 40, Section 2, Heping East Road, Da'an District, Taipei City. We operate entirely by appointment. Phone: (02) 2366-0186.

Written by: Dr. Ping-Sheng Lu

Last updated: August 25, 2026

Disclaimer: This article is for educational purposes only and cannot replace a doctor's diagnosis and treatment advice. If the warning symptoms described in the text appear, please seek medical attention immediately.

References

1. Biller J, Sacco RL, Albuquerque FC, et al.; on behalf of the American Heart Association Stroke Council. Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(10):3155-3174. doi:10.1161/STR.0000000000000016

2. Haldeman S, Carey P, Townsend M, Papadopoulos C. Clinical perceptions of the risk of vertebral artery dissection after cervical manipulation: the effect of referral bias. The Spine Journal. 2002;2(5):334-342. doi:10.1016/S1529-9430(02)00411-4