European Spine Journal

, Volume 17, Supplement 1, pp 176–183 | Cite as

Risk of Vertebrobasilar Stroke and Chiropractic Care

Results of a Population-Based Case-Control and Case-Crossover Study
  • J. David Cassidy
  • Eleanor Boyle
  • Pierre Côté
  • Yaohua He
  • Sheilah Hogg-Johnson
  • Frank L. Silver
  • Susan J. Bondy
Supplementary Research

Study Design

Population-based, case-control and case-crossover study.


To investigate associations between chiropractic visits and vertebrobasilar artery (VBA) stroke and to contrast this with primary care physician (PCP) visits and VBA stroke.

Summary of Background Data

Chiropractic care is popular for neck pain and headache, but may increase the risk for VBA dissection and stroke. Neck pain and headache are common symptoms of VBA dissection, which commonly precedes VBA stroke.


Cases included eligible incident VBA strokes admitted to Ontario hospitals from April 1, 1993 to March 31, 2002. Four controls were age and gender matched to each case. Case and control exposures to chiropractors and PCPs were determined from health billing records in the year before the stroke date. In the case-crossover analysis, cases acted as their own controls.


There were 818 VBA strokes hospitalized in a population of more than 100 million person-years. In those aged <45 years, cases were about three times more likely to see a chiropractor or a PCP before their stroke than controls. Results were similar in the case control and case crossover analyses. There was no increased association between chiropractic visits and VBA stroke in those older than 45 years. Positive associations were found between PCP visits and VBA stroke in all age groups. Practitioner visits billed for headache and neck complaints were highly associated with subsequent VBA stroke.


VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.


vertebrobasilar stroke case control studies case crossover studies chiropractic primary care complications neck pain 


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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • J. David Cassidy
    • 1
    • 2
    • 3
    • 4
  • Eleanor Boyle
    • 1
    • 2
  • Pierre Côté
    • 1
    • 2
    • 3
    • 4
    • 5
  • Yaohua He
    • 1
    • 2
  • Sheilah Hogg-Johnson
    • 3
    • 5
  • Frank L. Silver
    • 6
    • 7
  • Susan J. Bondy
    • 3
  1. 1.Centre of Research Expertise for Improved Disability Outcomes (CREIDO), University Health Network Rehabilitation SolutionsToronto Western HospitalTorontoCanada
  2. 2.Division of Heath Care and Outcomes ResearchToronto Western Research InstituteTorontoCanada
  3. 3.Department of Public Health Sciences, Management and EvaluationUniversity of TorontoTorontoCanada
  4. 4.Department of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  5. 5.Institute for Work & HealthTorontoCanada
  6. 6.University Health Network Stroke ProgramToronto Western HospitalTorontoCanada
  7. 7.Division of Neurology, Department of Medicine, Faculty of MedicineUniversity of TorontoTorontoCanada

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