Neck pain and headache as a result of internal carotid artery dissection: implications for manual therapists.

Physical therapy (PT) knowledge and literature relating to vascular issues in the cervical spine has traditionally paid particular attention to vertebrobasilar insufficiency (VBI) related to manipulation. Although internal carotid artery dissection (ICAD) and its sequelae are well reported in medical and chiropractic literature, only a few reports appear in PT texts. Internal carotid artery pathology has been documented as presenting with acute onset headache, facial and neck pain (Sturzenegger, 1995). Indeed, Smith et al. (2003) have suggested quite logically, that patients may seek spinal manipulative therapy (SMT) in the presence of a pre-existing cervical artery dissection which presents as neck and/or head pain. We report a case of ICAD in a 51-year-old male Physiotherapist. The ICAD appears to be the result of sneezing whilst in full cervical rotation, which to the authors’ knowledge has not been previously documented. The case study lends weight to the contention that arterial injury can present as mechanical onset neuromusculoskeletal (NMS) pain. The authors contend that subtle clues obtained during the subjective history taking and clinical reasoning process may alert the aware clinician of a potential vascular hypothesis, thus informing the decision with regard to management and potential SMT. Such case studies illustrate that a knowledge of haemodynamic issues relating to the cervical arteries