Neck Pain Post-Stroke: What You Need To Know

Neck pain is a common problem that most people experience at some point in their lives. While it usually isn't a cause for concern, in rare cases, it can be a sign of something more serious, such as an impending stroke. A stroke occurs when the blood supply to the brain is interrupted, and it can have devastating consequences. Therefore, recognising the link between neck pain and stroke, as well as other accompanying symptoms, can be crucial in seeking rapid treatment and preventing long-term damage.

Neck pain can be a warning sign of stroke

Neck pain is a mundane ache that most people experience at some point in their lives. It is usually not a cause for concern and often resolves on its own or with some rest and over-the-counter medication. However, in rare cases, sudden and severe neck pain can be a warning sign of an impending stroke. Recognizing this connection and other accompanying symptoms can help prompt rapid treatment and potentially save lives.

A stroke occurs when the blood supply to the brain is interrupted, resulting in damaged brain tissue. The two major types of strokes are ischemic stroke, which accounts for about 87% of cases, and hemorrhagic stroke, which makes up around 13%. Ischemic stroke is caused by a blockage in a blood vessel, often due to a clot, while hemorrhagic stroke involves bleeding into the brain when a blood vessel ruptures.

While neck pain is not a classic stroke symptom like facial drooping or numbness, it can sometimes serve as an early warning sign. One key mechanism is arterial dissection in the neck area, which involves a tear in the inner layer of an artery supplying blood to the brain. This allows blood to enter the arterial wall, causing pain and the formation of clots that can block blood flow, ultimately leading to a stroke. Dissection of either the carotid artery or vertebral artery in the neck is a leading cause of stroke in young and middle-aged adults, with neck pain often being the first symptom.

In addition to arterial dissection, researchers have identified other ways neck pain might be linked to stroke:

• Carotid artery disease: Plaque buildup in the carotid arteries in the neck can lead to reduced blood flow to the brain and an increased risk of stroke. The narrowing of these arteries may cause local neck pain.
• Vertebral artery issues: Blockages or other problems with the vertebral artery, a major neck artery supplying the brain, could result in neck pain and an elevated stroke risk.
• Recent neck injury: There is evidence that neck manipulation, such as chiropractic work or trauma, can damage arteries. Neck pain after such incidents might indicate this type of damage.
• Post-stroke tension and pain: Muscle spasms and changes in posture due to weakness on one side of the body following a stroke can cause neck pain in the days after the stroke.

It is important to recognize the signs and symptoms of stroke-related neck pain. Sudden and severe neck pain, especially when accompanied by other stroke indicators, should prompt urgent medical evaluation. Here are some clues that neck pain may be related to a stroke:

• The pain comes on very suddenly and is often described as a severe headache.
• It is generally on one side of the neck.
• Other stroke symptoms are present, such as numbness on one side of the body, difficulty speaking, or vision issues.
• There is a recent history of neck trauma or manipulation by a chiropractor or other healthcare provider.
• The neck is tender to touch, and movement exacerbates the pain.
• Headaches and neck stiffness accompany the pain.
• No recent injury or muscle strain explains the onset of neck pain.
• The presence of other stroke risk factors, such as high blood pressure, being overweight, or older age.

If you experience acute, severe neck pain, do not ignore it or try to tough it out. Call emergency services or seek immediate medical care, especially if you also notice facial drooping, arm weakness, or speech difficulties. Prompt treatment is crucial for preventing long-term stroke damage and potential complications like neck pain.

Carotid artery disease can cause neck pain and increase stroke risk

Carotid artery disease is a condition in which plaques build up inside the carotid arteries, causing them to narrow and restrict blood flow to the brain. While pain is not typically a symptom of carotid artery disease, it can cause neck pain in some cases due to the narrowing of the arteries. This condition is a leading cause of stroke in young and middle-aged adults, with neck pain often being the first symptom.

The carotid arteries are a pair of blood vessels located at the front of the neck that supply oxygen-rich blood to the front part of the brain, which controls thought, speech, personality, and the ability to feel physical sensations and move. Carotid artery disease can lead to reduced blood flow to this region of the brain, resulting in symptoms such as:

• Sudden numbness or weakness in the face, arm, or leg
• Sudden confusion or difficulty speaking or understanding speech
• Sudden difficulty seeing in one or both eyes
• Sudden difficulty walking, dizziness, or loss of balance and coordination
• Sudden severe headache with no obvious cause

If you experience any of these symptoms, it is crucial to call emergency services immediately, as they could indicate a stroke.

To reduce the risk of stroke and manage carotid artery disease, early diagnosis and treatment are essential. Doctors may recommend surgery to remove plaque or widen the artery using a stent. Additionally, lifestyle changes, such as a healthy diet, regular exercise, and smoking cessation, can help lower the risk of stroke.

Vertebral artery issues can cause neck pain and raise stroke risk

Vertebral artery issues can cause neck pain and increase the risk of stroke. The vertebral arteries are a pair of blood vessels that run along the back of the neck, supplying the brain and spine with oxygen-rich blood. A vertebral artery dissection occurs when there is a tear in one or more of the three tissue layers of the vertebral artery. This can cause blood to leak into the artery wall, leading to the formation of blood clots that can block blood flow to the brain and result in a stroke.

Vertebral artery dissection is a rare cause of stroke, accounting for only 2% of ischemic strokes. However, it is a common cause of stroke in young and middle-aged adults, with up to 25% of stroke cases in this age group being attributed to vertebral artery dissection. The risk factors for vertebral artery dissection include:

• Injury to the head or neck, such as from a car accident or whiplash.
• Non-traumatic injuries such as straining, heavy lifting, or extreme head positions.
• Rapid movements of the head, such as from roller coasters or chiropractic neck manipulation.
• Underlying health conditions such as connective tissue disorders or high blood pressure.

The symptoms of vertebral artery dissection include:

• Severe and sudden neck pain, usually on one side.
• Headache.
• Vertigo or dizziness.
• Numbness in the face.
• Difficulty speaking or swallowing.
• Vision problems.
• Loss of coordination.

It is important to seek medical attention if you are experiencing any of these symptoms, as prompt treatment can prevent lasting brain damage and long-term complications. Treatment for vertebral artery dissection typically includes medications to prevent blood clots, such as antiplatelet therapy or anticoagulants. In some cases, procedures such as stenting or surgery may be necessary to repair the artery.

A recent neck injury can cause neck pain and indicate stroke damage

Neck pain can be an early warning sign of stroke, but it is not a classic stroke symptom. Research has shown that a recent neck injury can cause neck pain and indicate stroke damage. A stroke occurs when the blood supply to the brain is interrupted, damaging brain tissue. This can be due to a blockage in a blood vessel or bleeding into the brain when a blood vessel ruptures.

A rare cause of stroke is a tear in one of the main arteries of the neck, known as a cervical artery dissection. This can lead to blood clots that block blood flow to the brain, resulting in a stroke. While cervical artery dissections are rare, they are one of the most common causes of stroke in people under 50. This type of injury can be caused by extreme positioning of the neck, trauma, or rigorous neck movements.

In addition, recent neck trauma or manipulation by a chiropractor or other healthcare provider can also cause neck pain and indicate stroke damage. This is because certain neck manipulations can damage arteries in the neck, leading to blood clots and a potential stroke. However, it is unclear whether the neck therapy itself causes the tear or if the pain from an existing tear prompts people to seek such treatment.

If you experience unusual, persistent neck pain, especially if it is accompanied by stroke symptoms such as dizziness, double vision, slurred speech, or numbness, it is important to seek immediate medical attention.

Muscle spasms and posture changes after a stroke can cause neck pain

After a stroke, the arms, legs, or face can become weak or paralyzed, and this weakness can lead to muscle spasms and posture changes that cause neck pain. In some cases, the neck pain may be the result of a recent neck injury or manipulation by a chiropractor or other provider. It is important to be evaluated by a medical professional to determine the underlying cause of the neck pain.

If you experience neck pain after a stroke, there are treatment options available. Physical therapy and exercise can help to improve movement and control, prevent other problems, and reduce pain. Your physiotherapist or occupational therapist will recommend exercises to lengthen and strengthen your muscles. Being active and continuing your exercises is important in managing spasticity.

In addition to physical therapy and exercise, there are other treatment options for spasticity, including:

• Injections of botulinum toxin to block nerves and relieve spasticity
• Oral medications to relax the nerves and prevent continuous muscle contraction
• Functional Electrical Stimulation/Neuromuscular Electrical Stimulations (NMES) to deliver a shock to the affected muscle and activate nerves
• Intrathecal baclofen therapy (ITB) to deliver medication directly to the spinal cord and minimize side effects
• Braces to hold muscles in a normal position and prevent contraction
• Surgical procedures for more severe cases

It is important to work with your healthcare team to determine the best treatment plan for your specific needs.

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