Some young adults who suffer migraines may be at risk for stoke from tears in their neck arteries, a new study suggests.
Of the nearly 2,500 stoke patients studied, aged 18 to 45, only 13% had strokes related to neck artery tears. This group was more likely to have high cholesterol, diabetes or be current smokers.
When the researchers looked closer at the pattern of migraines linked with vessel tears and stroke, they found that migraine without aura was more closely linked to the blood vessel abnormalities.
Aura describes sensory changes – such as flashes of light, other vision disturbances or tingling of hands or face – that can occur before or during a migraine.
“Overall, migraine is a benign condition in the great majority of affected individuals,” said Dr. Alessandro Pezzini, study author and professor of neurology at the Universita degli Studi di Brescia in Italy. The two disorders may have a common genetic basis, Pezzini said. Or an underlying abnormality may predispose a person to both the blood vessel problem and the stroke.
The findings were published online March 6 in the journal JAMA Neurology.
No triggering event is ever found for the tears in about half of cases, said Dr. Patrick Lyden, chair of neurology at Cedars-Sinai Medical. But he added, “the mechanism is often trauma, such as whiplash, incorrectly applied chiropractic manipulation or a sports-related neck-stretching accident.”
Lyden advises migraine patients to avoid risky activities. That means no chiropractic neck manipulation, he said.
This condition is called vertebral artery dissection (VAD) and is always a point of discussion at chiropractic license renewal seminars on standards of practice. However, the concern is not about causing a VAD but rather detecting one in progress.
All the research indicates that VAD is not a sudden event, but occurs slowly over the course of several days. One of the key symptoms is severe neck pain which often drives the patient to seek chiropractic care. That is, the VAD occurs prior to chiropractic manipulation.
I have a colleague that was sued for causing a VAD. He won the suit because the patient had gone to the hospital four days prior to seeking care in his office and the hospital missed the VAD, which was clearly visible on imaging studies. Despite winning the suit, he was bankrupt by legal costs, losing his home, office, savings and retirement.
Unfortunately, misinformation on this subject is still touted by medical authorities like Dr. Lyden. He either doesn’t keep up with the literature or chooses to ignore the studies.
The Bottom Line:
I have safely treated migraine patients with chiropractic manipulation for over 40 years. It’s really quite easy to alleviate a migraine headache. The hard part is prevention which is almost always a nutritional issue. Dr. Pezzini may be right about the genetic basis as I frequently find an impaired genetic snippet for the conversion of folic acid, vitamin B6 or vitamin B12 as the underlying problem that predisposes a person to migraine headaches.
March 6, 2017 National Institutes of Health