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Cervical Arterial Dysfunction
An unusual neck pain or headache accompanied by dizziness, visual changes or unsteadiness needs proper screening. It’s rare — but it’s exactly what a thorough assessment is for.
Overview
What Is Cervical Arterial Dysfunction?
Four arteries supply the brain, and two of them — the vertebral arteries — travel up through the bones of the neck. Cervical arterial dysfunction is an umbrella term for problems affecting these vessels or the carotid arteries, including dissection, where a tear in the vessel wall allows blood between its layers. It is rare, but it matters enormously because it can present with neck pain and headache and be mistaken for an ordinary musculoskeletal problem.
Use the buttons to see the features screened for at every neck assessment.
Pain That Doesn’t Fit
Sudden, severe neck pain or headache that the person describes as unlike anything they’ve had before, often at the back of the head or upper neck, and often out of proportion to any triggering event. The unfamiliarity of the pain is more significant than its exact location.
Symptoms
How It Tends to Feel
The features that raise concern are the ones that don’t belong in an ordinary neck presentation:
Unfamiliar Severe Pain
Sudden onset neck pain or headache described as the worst or most unusual the person has experienced.
Dizziness or Vertigo
Particularly when provoked by neck movement, and particularly alongside other neurological features.
Visual Disturbance
Double vision, transient loss of vision, or difficulty focusing.
Speech or Swallowing Changes
Slurred speech or difficulty swallowing occurring alongside neck pain.
Facial Numbness
Altered sensation over the face, sometimes on the opposite side to the neck pain.
Unsteadiness or Drop Attacks
Loss of coordination, staggering, or sudden collapse without loss of consciousness.
Causes & Risk Factors
What Drives It
Arterial dissection is often described as spontaneous, though a triggering event can frequently be identified in hindsight.
Minor Trauma
Sudden neck movement, a fall, a road traffic collision, or even vigorous coughing or sport can precipitate a tear in a vulnerable vessel.
Connective Tissue Disorders
Conditions affecting collagen structure increase vessel fragility and are over-represented in dissection cases.
Vascular Risk Factors
High blood pressure, smoking, raised cholesterol and diabetes contribute to atherosclerotic narrowing of the neck vessels.
Recent Infection
Recent respiratory infection is a recognised association, possibly through inflammatory effects on vessel walls.
Migraine
A history of migraine, particularly with aura, is associated with a modestly increased risk of dissection.
How We Can Help You
Treatment & Management
This is a page about recognition, not treatment. If arterial involvement is suspected, the role of your physio is to stop, refer and document — and to treat the neck properly only once it has been excluded.
What the evidence says
The International Federation of Orthopaedic Manipulative Physical Therapists framework for the cervical spine sets out the assessment standard for identifying vascular pathology before treating a neck, and forms the basis of the screening used here.
Cervical artery dissection is a leading cause of stroke in adults under 45. The most common initial presentation is neck pain or headache, frequently without any neurological signs at first — which is precisely why screening is routine rather than reserved for obvious cases.
When to Seek Help
This Page Is the Red Flag
If you have neck pain or headache accompanied by any of the following, this needs emergency assessment now, not a physiotherapy appointment:
⚠ Call 999 or attend A&E immediately if you have:
- Sudden, severe neck pain or headache unlike anything you’ve experienced before
- Double vision, loss of vision, slurred speech, or difficulty swallowing
- Facial drooping, facial numbness, or weakness down one side of the body
- Sudden loss of coordination, severe unsteadiness, or a drop attack
- Any of the above following a neck injury, however minor it seemed at the time
These can be signs of arterial dissection or stroke. Time matters a great deal. Call 999 — do not drive yourself, and do not wait to see whether it settles.
Common Questions
Frequently Asked Questions
Is neck manipulation dangerous?
The association between neck manipulation and arterial dissection has been debated for decades, and causation remains genuinely uncertain — people often seek treatment for the neck pain a dissection is already causing. The practical answer is that thorough screening comes first, and where there is any suspicion, end-range and high-velocity techniques are avoided altogether.
How common is this?
Rare. Cervical artery dissection occurs in the region of a few cases per 100,000 people per year. But it accounts for a meaningful share of strokes in younger adults, and its early presentation looks like ordinary neck pain — so the screening is worth doing every time.
Why did you ask me about my headaches and blood pressure?
Because those questions form part of the vascular screen. Taking a proper history of how the pain started, what it felt like, and what other symptoms accompanied it is how these presentations get identified. It takes a couple of minutes and it’s worth it.
I’ve had a dissection — can I have physiotherapy?
Yes, once your medical team has cleared you. Rehabilitation after dissection focuses on graded return to activity and confidence, working within whatever restrictions your consultant has set. your physio would want to liaise with them before starting.
Thorough Screening, Every Time
Every neck and headache assessment includes a proper vascular screen — because the rare things are exactly the ones you don’t want missed.
Book Your Initial AssessmentThis page is for general information only and isn’t a substitute for individual medical advice. If you have any of the emergency symptoms described above, call 999 immediately.