This study found no evidence of an increased risk of cervical artery dissection after chiropractor-administered cervical spinal manipulative therapy compared with ibuprofen prescription in adults seeking care for new episodes of neck pain or headache.
CeAD risk was significantly lower in the SMT cohort compared to the ibuprofen-prescribed cohort within 30 days of treatment.
Carotid artery dissection risk was significantly lower in the SMT cohort, while vertebral artery dissection risk was not significantly different between cohorts.
The study was designed to address protopathic bias, which may have previously overestimated associations between SMT and CeAD.
Data quality checks supported balanced confounders and minimal loss to follow-up across both cohorts.
The authors concluded that despite no increased CeAD risk with SMT, all clinicians including chiropractors should maintain vigilance for CeAD symptoms.
This research suggests that adults who received chiropractic spinal manipulation for neck pain or headache did not have a higher risk of cervical artery dissection (a tear in the arteries of the neck) compared to adults who were prescribed ibuprofen for the same symptoms. In fact, the study found the risk was statistically lower in the chiropractic group, though the absolute difference in events was very small — about 6 fewer cases per 100,000 patients. The study analyzed health records from over 860,000 matched patients in the United States between 2010 and 2025. A key feature of this study is that it was specifically designed to account for a problem called 'protopathic bias.' This bias occurs because people experiencing the early symptoms of a cervical artery dissection — such as neck pain or headache — may seek chiropractic care before their condition is diagnosed, making it look like the treatment caused the problem when it was actually already developing. By comparing chiropractic patients only to other people who also sought care for new neck pain or headache (and received ibuprofen), the researchers attempted to create a fairer comparison. This research matters because concerns about rare but serious vascular events have long been associated with neck manipulation, influencing clinical guidelines and patient decisions. These findings suggest that when comparing patients with similar presenting symptoms, chiropractic cervical manipulation does not appear to elevate the risk of cervical artery dissection relative to ibuprofen use. The authors emphasize that cervical artery dissection remains a rare event that all healthcare providers should watch for, and that further research — especially in specific patient groups like those with migraines — is still needed.
Trager R, Baumann A, Labak C, Lewis K, Perez J, Goertz C, et al.. (2026). Association between spinal manipulative therapy and cervical artery dissection in patients with neck pain or headache: a retrospective cohort study.. Chiropractic & manual therapies. https://doi.org/10.1186/s12998-026-00678-4