Head Massage Therapy: Stroke Prevention And Brain Health

A head massage can lead to serious complications like a stroke, according to neurologists. While a massage is meant to be a relaxing experience, it can quickly turn into a nightmare. This is due to the potential risk of vertebrobasilar artery (VBA) dissection, carotid artery dissection, or cervical artery dissection, which can occur when neck arteries are damaged, resulting in tears or ruptures. The vertebrobasilar artery, in particular, is vulnerable to injury when the neck is manipulated or stretched excessively during massages. Therefore, it is crucial to be aware of the risks associated with head massages and to take preventive measures to minimize the risk of stroke.

Head massages can cause vertebral artery dissection (VAD)

VAD occurs when there is a tear in one or more of the three tissue layers of the vertebral artery, allowing blood to enter the arterial wall and form a clot. This clot thickens the artery wall and often impedes blood flow, leading to a risk of life-threatening complications. While VAD is rare, accounting for only 2% of all ischemic strokes, it is a common cause of stroke in young and middle-aged adults, contributing to 10-25% of strokes in this age group.

The risk of VAD is heightened by certain factors. Firstly, it is associated with physical trauma to the neck, such as sudden neck movements, spinal manipulation, or sports injuries. Additionally, it can be triggered by genetic factors like connective tissue disease and environmental factors related to hyperextension or rotation of the neck, including yoga, painting, coughing, and sneezing.

The symptoms of VAD include head and neck pain, as well as stroke-like symptoms such as difficulty speaking, impaired coordination, and visual disturbances. It is crucial to seek immediate medical attention if these symptoms arise, as timely treatment can significantly improve outcomes and reduce the risk of long-term disabilities.

To minimize the risk of VAD during head massages, it is important to choose licensed massage therapists who employ gentle and controlled techniques. Avoiding excessive neck extension and communicating any discomfort during the massage are also important preventive measures. For individuals with pre-existing vascular conditions, such as high blood pressure or diabetes, caution is advised as they are at a higher risk of artery damage during such activities.

VAD can lead to strokes

Vertebral artery dissection (VAD) is a flap-like tear of the inner lining of the vertebral artery, which is located in the neck and supplies blood to the brain. After the tear, blood enters the arterial wall and forms a blood clot, thickening the artery wall and often impeding blood flow. This obstruction of blood flow can lead to dysfunction in the part of the brain supplied by the artery, which happens in 77-96% of cases. This can be temporary, but many cases (67-85%) result in a permanent deficit or a stroke.

VAD is a rare cause of stroke in the general population, but it is one of the more common causes of stroke in patients younger than 45. It is estimated that VAD is responsible for at least 20% of ischemic strokes in young people and is the cause of approximately 2% of all ischemic strokes. However, in middle-aged individuals (30-45 years old), the incidence can be as high as 10-25%.

VAD can be caused by physical trauma to the neck, such as a blunt injury or strangulation, or sudden neck movements like coughing. It can also be caused by neck distortion due to chiropractic manipulation or bending of the neck. Blunt trauma to the neck is the most commonly reported precipitating event.

The dissection of the artery may lead to a stroke, which can be delayed for days following the acute dissection. Neurological symptoms may be delayed or not present at all, but 70% of patients will have some type of neurological deficit that may present late.

VAD can also be caused by spontaneous dissections, which are considered to be due to intrinsic factors that weaken the arterial wall. However, only a very small proportion (1-4%) have a clear underlying connective tissue disorder, such as Ehlers-Danlos syndrome type 4 or Marfan syndrome.

To prevent VAD and the associated risk of stroke, it is important to choose licensed massage professionals who use controlled, gentle techniques and to avoid excessive neck extension during hair washing or massages. Communicating any discomfort or pain to the therapist is crucial to prevent further damage. For individuals with vascular conditions such as high blood pressure or diabetes, caution is advised during massages as they are at a higher risk of artery damage.

Head massages can cause carotid artery dissection

A stroke is a frightening occurrence that can happen suddenly and seemingly without warning. It is a brain attack that occurs when the blood supply to the brain is cut off, damaging or killing brain cells. This damage determines the effect the stroke will have on the individual. While strokes are often associated with older people, they can happen at any age, even in children.

One of the types of stroke is the ischemic stroke, which is the most common type and is caused by a blockage cutting off the blood supply to the brain. A head massage or shampoo can lead to an ischemic stroke due to the potential risk of artery dissection.

The carotid artery is located in the anterior triangle of the neck. A carotid artery dissection is a tear in the inner wall of the artery. This can be caused by trauma or significant pressure, such as deep pressure applied during a neck massage. The risk of stroke after carotid sinus massage is greater if there is pre-existing carotid stenosis or carotid plaques.

Case Studies

There have been several reported cases of individuals suffering from strokes after receiving neck massages. In one instance, a 41-year-old woman, Stefanie Smith, died from a carotid artery dissection after receiving a massage at a resort spa. Another case involved a 58-year-old man who developed a watershed stroke after performing a self-neck massage in a hospital stroke unit. He had underlying carotid artery stenosis, which was unknown to him at the time.

Preventive Measures

To minimize the risk of stroke during head massages, it is important to take certain precautions:

• Always opt for experienced, licensed massage professionals who use controlled, gentle techniques.
• Avoid excessive neck extension during a hair wash and use towels to support a safer neck position.
• Communicate any discomfort or pain immediately to the therapist to prevent further damage.
• Individuals with pre-existing vascular conditions, such as high blood pressure or diabetes, should be cautious and inform their therapist before the massage.

Recognizing Stroke Symptoms

Recognizing the signs of a stroke early is critical for effective treatment. The American Stroke Association recommends using the acronym FAST:

• Face: Look for drooping on one side of the face.
• Arms: Check if one arm drifts downward when raised.
• Speech: Listen for slurred or garbled speech.
• Time: If any of these signs are present, seek emergency medical attention immediately.

Other symptoms of a stroke caused by neck manipulation include dizziness, nausea, and visual disturbances.

Head massages can cause cervical artery dissection

The risk of cervical artery dissection is heightened for people with pre-existing vascular conditions, such as atherosclerosis or hypertension. Certain massage techniques, like deep tissue pressure or excessive force, can also increase the likelihood of artery damage. It is crucial to seek massages from licensed therapists who use gentle, controlled techniques to minimise the chance of neck injury.

The vertebrobasilar artery (VBA), in particular, is vulnerable to injury when the neck is manipulated or stretched excessively during a massage. VBA dissection can lead to stroke, and strokes associated with VBA dissection often occur in middle-aged individuals.

There have been several reported cases of vertebral artery dissection (VAD) following neck massages or the use of handheld massage devices. VAD is a common cause of stroke, especially in young and middle-aged adults, with up to 25% of stroke cases in this age group attributed to VAD.

The symptoms of VAD include dizziness, nausea, vomiting, tinnitus, imbalance, headache, neck pain, and gait abnormalities. Early identification of VAD is crucial for improving patient outcomes, so it is important to be vigilant for these signs.

Head massages can be safe if certain precautions are taken

Head massages can be enjoyable and relaxing, but it's important to take some precautions to ensure they are safe and do not lead to serious complications such as a stroke. Here are some essential precautions to keep in mind:

Choose Licensed and Experienced Professionals

It is crucial to select experienced and licensed massage therapists who are well-versed in controlled and gentle techniques. Avoid untrained individuals offering massages, as they may not have the necessary skills to perform the massage safely.

Limit Neck Extension and Rotation

Excessive neck extension and rotation during a head massage can be dangerous. Avoid vigorous movements and overextension of the neck. Use towels to support and maintain a safer neck position during the massage.

Communicate Discomfort

If you experience any discomfort or pain during the massage, immediately communicate it to your therapist. Do not endure the pain silently, as it may indicate potential injury or damage to blood vessels in the neck.

Monitor Pre-existing Conditions

Individuals with pre-existing vascular conditions, such as high blood pressure, diabetes, atherosclerosis, or hypertension, are at a higher risk of artery damage during head massages. Consult your doctor before getting a head massage if you have any of these conditions.

Recognize Stroke Symptoms

It is important to be able to recognize the signs of a stroke, as timely intervention is critical for effective treatment. Remember the acronym "FAST":

• Face: Look for drooping or asymmetry on one side of the face.
• Arms: Check if one arm drifts downward when raised.
• Speech: Listen for slurred or garbled speech.
• Time: If any of these signs are present, seek emergency medical attention immediately.

Additionally, dizziness, nausea, and visual disturbances can also be indicators of a stroke caused by neck manipulation.

By following these precautions, you can help ensure that your head massage is safe and enjoyable, reducing the risk of any adverse events such as a stroke.

Frequently asked questions