Vertebral Artery Dissection: Symptoms, Risks, and Recovery
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
TL;DR: Vertebral artery dissection (VAD) is a rare but potentially life-threatening tear in the wall of an artery that supplies blood to the brain and spine. Dissections of the neck arteries account for only a small share of all strokes [1], yet they are a common cause of stroke in adults under 45. [1] Warning signs often begin with one-sided neck pain and a severe headache, which can be followed by dizziness, vertigo, or vision changes. Most dissections heal with medical management, usually blood-thinning medication, while a minority need a procedure. Recovery involves regular imaging and temporary limits on neck-straining activity.
Quick Answer
Vertebral artery dissection is a tear in the wall of a vertebral artery, one of the two vessels along the back of the neck. Trapped blood can form a clot or bulge that may cause a stroke. [1] Risk factors include connective tissue disorders, high blood pressure and neck trauma. Blood thinners prevent clots, and most people recover fully. [1]
What the research says
Dizziness, headache, and neck pain are the most common warning signs. A systematic review of 75 studies describing 1,972 patients with symptomatic VAD found dizziness or vertigo in 58%, headache in 51%, and neck pain in 46%; stroke occurred in 63%, and 67% had a good outcome (modified Rankin scale 0–1) (Gottesman et al., Neurologist, 2012) [2].
Anticoagulants cut early stroke risk but raise bleeding risk. In a meta-analysis of 11 studies (5,039 patients with cervical artery dissection, which includes vertebral artery dissection), anticoagulation was associated with a lower risk of ischemic stroke than antiplatelet therapy (RR 0.63, 95% CI 0.43–0.94) but a higher risk of major bleeding (RR 2.25, 95% CI 1.07–4.72) (Yaghi et al., Stroke, 2024) [3].
A second dissection is uncommon. A meta-analysis of 29 studies (5,898 patients with carotid or vertebral artery dissection) found recurrent dissection in 4% overall (95% CI 3–7%), 2% at one month, and 7% at one year in studies with sufficient follow-up (Lounsbury et al., Int J Stroke, 2024) [4].
What Is Vertebral Artery Dissection?
Vertebral artery dissection (VAD) is a tear in one or more of the three tissue layers that make up the vertebral artery. [1] You have two vertebral arteries. [1] They run along the back of the neck, near the spine bones (vertebrae), and deliver oxygen-rich blood to the brain and spine.
The artery wall has three layers: the intima (inner layer, closest to the blood flow), the media (middle layer), and the adventitia (outer structural layer). When a dissection occurs, blood enters the space between these layers. [1] That trapped blood can form a clot or a bulge that disrupts normal blood flow. [1]
VAD is rare in the general population, but it matters most in younger people. Dissections of the neck arteries cause only a small percentage of all strokes, yet up to 25% of strokes in young and middle-aged adults are due to neck artery (cervical artery) dissections, which include vertebral artery dissection. [1]
Recognizing the Symptoms
In the early stages, a vertebral artery dissection may not cause noticeable symptoms. [1] As the condition progresses, or if a complication such as a stroke occurs, warning signs can emerge.
Symptom Type | Common Signs |
Pain | Persistent, usually one-sided neck pain and severe, sudden-onset headaches. [1] |
Balance and dizziness | Dizziness, vertigo, and ataxia (trouble with balance or coordination). [1] |
Vision and hearing | Double vision and hearing loss. [1] |
Speech | Slurred speech, also known as dysarthria. [1] |
Recognizing these signs early matters, especially if they follow a neck injury or sudden neck movement, because prompt diagnosis can reduce the risk of long-term complications.
Seek emergency care: Sudden severe neck pain or headache together with dizziness, double vision, slurred speech, or weakness can signal a stroke. Call your local emergency number right away instead of waiting to see whether the symptoms pass.
Causes and Risk Factors
A vertebral artery dissection can occur for no known reason or after an injury. [1] Certain underlying health conditions can weaken the artery wall and raise the risk of a tear.
Medical Risk Factors
People with connective tissue and vascular conditions such as Ehlers-Danlos syndrome, Marfan syndrome, or fibromuscular dysplasia are at higher risk. [1] Other contributing factors include high blood pressure, smoking, polycystic kidney disease, osteogenesis imperfecta, and vasculitis. [1]
Physical and Traumatic Triggers
Sudden or prolonged neck movements can trigger a dissection. Common examples include:
Trauma: car accidents, wrestling, or heavy weight lifting. [1]
Neck positioning: keeping the neck hyperextended (looking upward) for long periods, such as when painting a ceiling or practicing certain yoga poses. [1]
Sudden movements: sneezing, vomiting, or blowing the nose too forcefully. [1]
Manual therapy: chiropractic adjustments or deep tissue neck massage. [1]
Diagnosis and Clinical Testing
When a vertebral artery dissection is suspected, healthcare providers use imaging to confirm the diagnosis and judge its severity. Magnetic resonance angiography (MRA), which combines MRI with angiography, is a widely used noninvasive test [1] because it shows detailed images of the arteries and the extent of the tear. MRA is not widely available [1], though, so in emergency settings a CT scan or CT angiography is often the first test. In some complex cases, conventional angiography, which uses a catheter and contrast dye to view blood flow in real time, may be recommended.
Management and Recovery
The main goal of treatment is to prevent blood clots that could lead to a stroke.
Medical Treatment
Most dissections heal on their own. [1] First-line treatment usually involves blood-thinning medication, such as aspirin or aspirin-like drugs, heparin, or warfarin, to reduce the risk of clots. [1] If the dissection reaches the brain or has caused a hemorrhagic stroke, blood thinners may not be safe [1], and your care team will recommend alternative treatments.
Specialized Procedures
If medication is not enough, or the case is severe, a procedure may be needed:
Angioplasty and stenting: a balloon repairs the dissected section of the artery, and a mesh-like metal device (stent) reinforces the vessel wall. [1]
Endovascular embolization: an embolic agent or tiny metal coils seal off the abnormal section of the vessel. [1]
Surgery: metal clips seal off the vessel [1] when an endovascular procedure is not possible.
Recovery and Monitoring
Most people make a full recovery, and the risk of another dissection decreases over time. [1] You will need regular monitoring until your healthcare provider confirms that the artery has healed, typically with MRA every three to six months [1], and you may need to keep taking a blood thinner during this time. [1] While you heal you can still exercise, but avoid activities that strain or jolt the neck until your doctor clears you. These include lifting more than 25 to 30 pounds (about 11 to 14 kg), push-ups, pull-ups, contact sports, and chiropractic or deep tissue neck manipulation. [1]
Conclusion
Vertebral artery dissection is a complex condition that needs prompt medical attention to prevent serious complications such as stroke. The risk of a life-threatening event is real, but the high recovery rate for people who receive timely diagnosis and treatment is encouraging. By understanding the risk factors, from connective tissue disorders to sudden neck movements, and by recognizing the early warning signs of neck pain and headache, you can seek care sooner. With medical management, regular monitoring, and careful activity restrictions, most people go on to a full and healthy recovery.
Related reading: Vertebral artery anatomy · Carotid artery · Stroke · Marfan syndrome · Fibromuscular dysplasia · Neck pain
Frequently Asked Questions
Can I fully recover from a vertebral artery dissection?
Yes. Most people who have a vertebral artery dissection make a full recovery with proper medical management and monitoring.
Is VAD the same as a carotid artery dissection?
VAD and carotid artery dissection are similar but affect different vessels. A carotid artery dissection involves the arteries at the front of the neck, while a vertebral artery dissection affects the arteries at the back of the neck. Both are types of cervical artery dissection.
How long does it take for the artery to heal?
Healing time varies from person to person. Doctors typically monitor progress with imaging, usually every three to six months, until healing is confirmed.
Are there activities I should avoid during recovery?
Yes. Until your doctor clears you, avoid lifting more than 25 to 30 pounds, push-ups, pull-ups, contact sports such as football or wrestling, and other activities that could cause whiplash or prolonged neck hyperextension.
Is neck pain always present?
Neck pain is a very common symptom, usually on one side, but it is not always present in the very early stages of a dissection.
Can a chiropractor cause VAD?
While rare, certain chiropractic adjustments involving sudden neck movements have been identified as a potential trigger for vertebral artery dissection.
What is the difference between an ischemic and a hemorrhagic stroke?
An ischemic stroke occurs when a clot blocks blood flow, while a hemorrhagic stroke occurs when an artery ruptures and spills blood into or around the brain.
Does smoking increase the risk of VAD?
Yes. Smoking is a known risk factor because it can contribute to damage to the artery walls over time.
Is VAD common in older adults?
VAD is a rare cause of stroke in older adults. It is much more commonly identified as a cause of stroke in people younger than 45.
Can I exercise after a dissection?
You can still exercise, but you must follow your doctor's specific restrictions on intensity and on movements that strain the neck until you are fully cleared.
References
Cleveland Clinic. Vertebral Artery Dissection: Symptoms & Treatment. Cleveland Clinic. Last updated 08/07/2022. https://my.clevelandclinic.org/health/diseases/23961-vertebral-artery-dissection
Gottesman RF, Sharma P, Robinson KA, et al. Clinical characteristics of symptomatic vertebral artery dissection: a systematic review. Neurologist. 2012;18(5):245-254. PMID 22931728. https://doi.org/10.1097/NRL.0b013e31826754e1
Yaghi S, Shu L, Fletcher L, et al. Anticoagulation versus antiplatelets in spontaneous cervical artery dissection: a systematic review and meta-analysis. Stroke. 2024;55(7):1776-1786. PMID 38847098. https://doi.org/10.1161/STROKEAHA.124.047310
Lounsbury E, Niznick N, Mallick R, et al. Recurrence of cervical artery dissection: a systematic review and meta-analysis. Int J Stroke. 2024;19(4):388-396. PMID 37661311. https://doi.org/10.1177/17474930231201434
Medical disclaimer
This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions about a medical condition.
Comments