What are the risk factors associated with vertebral artery dissection (VAD)?

Updated: Feb 21, 2019
  • Author: Eddy S Lang, MDCM, CCFP(EM), CSPQ; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Several risk factors have been associated with the development of VAD. These include the following:

  • Spinal manipulation [6, 15, 16, 19, 20, 21, 22] : Has one of the best studied and strongest demonstrated associations with VAD (The Canadian Chiropractic Association, Canadian Federation of Chiropractic Regulatory Boards, Clinical Practice Guidelines Development Initiative, Guidelines Development Committee have specific recommendations on assessment of signs of impaired vertebral artery flow and recommendations for treating or not treating patients with suspected impaired flow. [23] )

  • Vertebral artery hypoplasia [24]

  • Yoga

  • Ceiling painting

  • Nose blowing

  • Minor neck trauma

  • Judo

  • Medical risk factors

  • Hypertension [25] (48% in one series)

  • Oral contraceptive use

  • Chronic headache syndromes/migraines  [6, 9, 16]

  • Intrinsic vascular pathology

  • Cystic medial necrosis

  • Female sex

  • Postpartum (rare) [26]

  • Recent infection [12]

When patients with serious cervical trauma, such as cord injuries or cervical spine fractures, are screened for vertebral artery injury, 20-40% may demonstrate traumatic occlusion. This traumatic vertebral artery occlusion (as opposed to dissection) is asymptomatic, and its management is controversial.

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