Is Chiropractic Care Safe? What a 2025 Landmark Study Says About Neck Adjustments and Stroke Risk

At Synergy Wellness Studios, we understand that some people hesitate to seek chiropractic care because of concerns they've heard about neck adjustments and stroke. We want to address that fear honestly, with the best science available — and reassure you that your safety is always our first priority.

If you've ever Googled "chiropractic and stroke" before booking an appointment, you're not alone. It's one of the most common concerns we hear from new patients, and it's a completely valid question to ask. The good news is that a major new study published in 2025 gives us the clearest, most rigorous answer yet — and what it found should give you real peace of mind.

What Is Cervical Artery Dissection (CAD)?

Cervical artery dissection (CAD) is a rare condition in which a small tear develops in the inner lining of one of the arteries in the neck. It can sometimes lead to stroke, and because the neck is involved, it has historically been linked — often unfairly — to chiropractic neck adjustments. For years, this connection was debated hotly between the chiropractic and medical communities. The problem? Most of the research fueling that debate was fundamentally flawed.

Why the Old Research Got It Wrong

Most prior studies compared CAD patients to other stroke patients — not to healthy people. This introduced what scientists call selection bias, meaning the research was essentially asking the wrong question from the start. It could tell you what makes a stroke more likely to be CAD-related, but it couldn't actually tell you what causes CAD in the first place.

That distinction matters enormously — especially for you as a patient trying to make an informed decision about your care.

What the 2025 Study Did Differently

A team of researchers published a systematic review with meta-analysis in the journal Stroke and Vascular Neurology — one of the most rigorous types of studies in medicine, because it pools and analyzes data from many studies at once. This one examined 128 studies, with 54 of them specifically comparing CAD patients to healthy individuals. By using healthy controls, it finally answered the right question: What actually increases a person's risk of developing CAD?

The findings were organized by the strength of the evidence.

What Actually Increases CAD Risk

Strong Evidence (Moderate Certainty)

The two most reliably supported risk factors were:

• Migraine history — People with migraines have approximately 2.3 times the risk of CAD, and this finding held up consistently across studies regardless of whether migraines occurred with or without aura.

• MTHFR TT gene variant — A specific genetic variant that affects how the body processes an amino acid called homocysteine was associated with nearly 3 times the risk. Most people don't know whether they carry this variant, but it's worth discussing with your doctor if you have a family history of stroke or vascular conditions.

Moderate Evidence (Low Certainty)

• Minor trauma to the neck — The strongest odds ratio in the data, though the definition of "minor trauma" varied widely between studies, making the evidence harder to interpret with precision.

• High blood pressure (hypertension) — A more modest association, but one that appeared consistently across multiple studies.

Weaker Evidence (Very Low Certainty)

Several additional factors showed up in the research but with less reliable data behind them:

• Recent infection (particularly with elevated white blood cell counts)

• Autumn and winter seasons (which track with higher infection rates)

• Oral contraceptive use

• Connective tissue disorders

• Certain cardiovascular variants

These are useful pieces of the clinical picture, but the evidence isn't strong enough to draw firm conclusions from them alone.

What About Chiropractic Neck Adjustments?

Here is the most important finding for anyone with concerns about chiropractic care:

Cervical spinal manipulation showed no significant increased risk of CAD.

The pooled odds ratio from the data was 0.64 (95% confidence interval: 0.26–1.6) at 30 days — a finding that does not support a causal link between neck adjustments and cervical artery dissection.

So why did the old research suggest otherwise? The answer comes down to a concept called care-seeking behavior. People in the early stages of a CAD event often experience neck pain and headache — the same symptoms that lead people to visit a chiropractor. In other words, patients were coming to chiropractors because they were already developing CAD symptoms, not the other way around. The care didn't cause the problem. The symptoms brought them through the door.

What This Means for You as a Patient

Understanding the actual risk factors for CAD allows your chiropractor to provide smarter, safer, more personalized care. At Synergy Wellness Studios, Drs. Patrick Stromer and Stormie Johanson stay current with the research specifically so they can do exactly that.

Here's what that looks like in practice:

If you have a history of migraines, our doctors will take note of that as a meaningful clinical signal. Patients presenting with headache or neck pain alongside migraine history receive extra attention, modified manual therapy approaches when appropriate, and thorough neurological baseline documentation — not because manipulation is dangerous, but because informed, individualized care is always the standard.

If you've recently had an infection or are feeling under the weather, that context matters. Research suggests recent infections may correlate with a temporarily elevated CAD risk window. Our doctors factor in your current health status before every visit.

If you have high blood pressure or a connective tissue condition, those details will shape how we approach your care from the very first appointment.

None of this means you can't be adjusted. It means your care will be thoughtfully tailored to you — your history, your health, and your individual risk profile.

Honest Conversations, Evidence-Based Care

We believe you deserve to walk into our office informed, not afraid. Current evidence does not support the idea that chiropractic neck adjustments cause stroke in otherwise healthy individuals. What the research does show is that certain pre-existing health factors — migraines, genetics, hypertension — are the real variables that deserve attention.

Our doctors are trained to identify those variables, have honest conversations with you about them, and adjust (pun intended) our approach accordingly. If there is ever a situation where we believe a different type of care or a referral to another provider is in your best interest, we will tell you — because that is what genuine patient-centered care looks like.

If you've been hesitant to book an appointment because of concerns about safety, we hope this gives you the clarity and confidence to take that next step. We'd love the opportunity to sit down with you, learn about your health history, and show you what thoughtful, research-informed chiropractic care can do for your life.

Ready to get started? Contact Synergy Wellness Studios at 208-417-6849 or synergywellnessboise@gmail.com. We have locations in Boise and Meridian, ID, and we're here Monday through Friday by appointment.

Source: "Risk factors for cervical artery dissection: a systematic review with meta-analysis." Stroke and Vascular Neurology, 2025.