People who got a chiropractic neck adjustment for new neck pain or headache were not more likely to suffer a neck artery tear in the next 30 days than similar people who were prescribed ibuprofen, according to a study of more than 862,000 US adults published this month in Chiropractic & Manual Therapies.
If you get neck adjustments, this gives you better numbers on a rare, stroke-related risk. It does not prove the adjustments are risk-free, and it does not change one rule: sudden, severe neck pain or headache, especially on one side, that comes with dizziness, vision changes, or slurred speech is a reason to go to the ER, not to a chiropractor.
Key takeaways
- About 7 in 100,000 people had a neck artery tear within 30 days of an adjustment, compared with about 13 in 100,000 given ibuprofen.
- The study does not show that adjustments protect your arteries. The gap more likely reflects bias the design could not fully remove.
- Stroke itself was not measured. The warning signs of an artery tear matter more than this result.
What the study found
A tear in the wall of a neck artery is called a cervical artery dissection. It is rare, but it can lead to stroke. For years, doctors have debated whether neck manipulation can cause one.
The researchers used US health records and insurance claims from 2010 to 2025. They looked at adults seeking care for a new episode of neck pain or headache. They left out anyone with a past artery tear or earlier disease of the brain’s blood vessels, then matched 431,492 people who got a chiropractic neck adjustment with 431,492 people who instead had a doctor visit and an ibuprofen prescription.
Within 30 days, 31 people in the chiropractic group and 58 in the ibuprofen group were diagnosed with a new neck artery tear, according to University Hospitals Cleveland.
That works out to about 47% lower risk in the chiropractic group (risk ratio 0.53). The true figure is very likely somewhere between 17% and 65% lower. There is about a 4 in 1,000 chance this gap is a coincidence.
In absolute terms, that is about 6 fewer tears per 100,000 people over 30 days (very likely between 2 and 11 fewer). The authors themselves called this difference minimal.
Tears in the carotid arteries, at the front of the neck, were less common after adjustments. Tears in the vertebral arteries, at the back of the neck, were not significantly different between groups.
Dr. Kumar’s take
No one thinks ibuprofen causes artery tears. So if neck adjustments were simply harmless, the two groups should have looked about the same. Instead the chiropractic group did better. A neck adjustment is very unlikely to protect an artery. The more likely explanation is that the two groups were still different in ways the matching did not capture.
Here is the core problem. A tearing artery often shows up first as neck pain or headache. That means some people who go for care are already having a tear. The authors call this protopathic bias and tried to limit it by only including new neck pain or headache. But the choice of where to go is not random. Someone with an unusual, severe headache may be more likely to see a doctor than a chiropractor, and that alone could put more tears in the ibuprofen group.
The paper gives a clue here too. The authors used “negative control outcomes,” conditions that neither treatment should affect, to check whether the groups were truly comparable. Those checks were only partially balanced. That is a sign some leftover bias remains.
The study also did not measure stroke, the outcome people actually fear; the authors list it for future research. And the lead author, Robert Trager, is a chiropractor who directs chiropractic medicine at University Hospitals, and the paper appears in a chiropractic journal. The team did include cardiology, neurosurgery, and physical therapy authors, and they registered their plan in advance, which is to their credit. Still, a co-author calling this “some of the best evidence yet” that chiropractic neck care is safe goes further than an observational study can.
My read: this makes it less likely that adjustments cause many artery tears. It does not show they cause none, or that they are safer than a doctor visit.
What it means for you
- If you already get neck adjustments and feel fine afterward, this study does not give you a new reason to stop. Whether they suit your neck is still a question for your doctor.
- Know the warning signs. The researchers say every clinician should watch for sudden or unusual headache, neck pain unlike your usual pattern, or nerve symptoms. From a neurosurgeon’s view, add dizziness, double or blurred vision, trouble speaking, weakness, or numbness on one side.