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Neck artery tears (cervical artery dissection) can be sneaky, sometimes causing only pain.†See Arnold 2006, Kerry 2009, Maruyama 2012 Some people with neck pain and/or headache may actually have damaged neck arteries, and are at a high risk for stroke. There are two arteries in the neck that do this:
This is the stuff of hypochondriac nightmares, because it’s such a serious problem that can almost perfectly mimic such an ordinary, common problem. But it’s not a perfect mimic. The pain is usually dramatically bad and weird. †Arnold et al: “Pain was different from earlier episodes in all but one case [of 20].” Maruyama et al:
All but one patient [of seven] with migraine considered the pain to be unique and unusual compared with previously experienced headache or neck pain episodes. Nevertheless, pain was often interpreted initially as migraine or musculoskeletal in nature by the patient or the treating doctor.
Everything else about the pain is less predictable.†Arnold “Pain topography, dynamics, quality and intensity were heterogeneous.” In other words, there are almost certainly some cases that are effectively impossible to distinguish from ordinary neck pain and headache. Many but by no means all cases are:
And then of course there could be other, stranger symptoms. If some cases cause only pain, but most cases have more traditional symptoms of arterial dissection, then there are surely some stuck in the middle: a lot of pain, and a few subtle hints of the more serious problem. Any neuro-ish symptoms in combination with severe, strange pain should jack the clinical suspicion up as high as it can go, and it should be treated like an emergency.
Specifically, what else might be going on? First, keep the F.A.S.T. signs of stroke: face drooping, arm weakness, speech difficulty… time to call 911! Non-stroke (or pre-stroke) symptoms associated with artery tears: neck swelling, reduced vision and/or visual disturbance, constricted pupil, drooping eyelid, pulsatile ringing in the ears, decreased taste.
I’ve updated my articles on tension headaches and scary causes of neck pain with this information, and of course my full neck pain tutorial. It’s also strongly relevant to the potential harms of chiropractic adjustment of the neck: what if you sought chiropractic care for neck pain, and the pain was the only symptom a damaged artery? Spinal manipulative therapy in that situation would be crazy dangerous!
Fat does not clog arteries, and heart disease — heart attacks, clots, strokes, etc — is a chronic inflammatory disease, mainly treated with exercise, avoiding junk food, and relaxing. See this controversial editorial from the British Journal of Sports Medicine about heart disease:
It is time to shift the public health message in the prevention and treatment of coronary artery disease away from measuring serum lipids and reducing dietary saturated fat. Coronary artery disease is a chronic inflammatory disease and it can be reduced effectively by walking 22 min a day and eating real food. There is no business model or market to help spread this simple yet powerful intervention.”
Please also read these strong, credible criticisms of this BJSM editorial that go further than I would have expected. Regarding the author, who apparently has a huge bias I was not aware of:
Malhotra, who maintains a high profile on media sites and television, has long advocated for high-fat diets, and he has blamed the rise of obesity and other health problems solely on sugar and processed foods. He has written scores of editorials and recently produced a documentary on the matter. Last year, Malhotra drew intense backlash from health experts after co-writing a report that encouraged people with type II diabetes and obesity to fight their diseases by eating more fat and ditching efforts to keep track of calories.
Regardless, it’s mostly the claims about saturated fat that are problematic. My focus was on the inflammatory etiology, because it is probably also a factor in chronic pain and vulnerability to overuse injuries like tendinitis or runner’s knee.
Also take note: this is mainstream medicine here, strongly emphasizing the value of diet, exercise, and stress reduction, defying the cynical stereotype.
Read more here on PainScience.com about chronic inflammation and the morbidly fascinating concept of “inflammaging”: Chronic, Subtle, Systemic Inflammation.
Earlier this week I shared my ice vs. heat article on social media. Although super popular, I got lots of pushback from icing apostates who are convinced that icing is bad because it supposedly interferes with natural healing.
Not so fast, debunkers! I love a good debunking as much as the next guy — probably more, actually! — but I just don’t buy this one.
The argument that icing impedes healing is speculative and clearly contradicted by the clinical evidence. In fact, icing appears to have no effect on recovery at all, good or bad. There is no obvious impeding going on, no matter how much “common sense” it makes, regardless of what we think we know about inflammation and the effects of icing.
And there are other problems, like the assumption that everything natural is good. It’s really not.
Read more! I’ve just upgraded my commentary on this topic: see the first section of Icing for Injuries, Tendinitis, and Inflammation.
Why do muscles often contract without permission? Can cramps be treated? Should you worry about twitches and tremors? Do backs actually “spasm”? What’s going on when we feel “tight” and “stiff”? Why doesn’t anaesthesia actually paralyze muscles? Is there such a thing as “muscle splinting”? And more!
It’s not a rough draft, but it’s hardly complete either: I’ve just scratched the surface of this fascinating topic, and dealt efficiently with a few prominent myths and controversies. I know I’ve completely missed some important sub-topics, and probably gotten some things wrong, and I’m sure readers will let me know.
I realized I had to write this last year while I was reading Life's Ratchet: How molecular machines extract order from chaos, from the “molecular storm” (such a cool image). I was especially motivated by the chapter about the molecules of movement and muscle:
“There is not one type of kinesin, myosin, or dynein doing one type of job. Instead, like a fleet of customizable trucks, there are superfamilies of molecular motors, with eighteen known classes of myosins, ten classes of kinesins, and two classes of dyneins.”
Muscle physiology is just bonkers. This isn’t a particular technical article, but the rabbit hole it’s built over goes deep.
For all the truly wondrous developments of modern medicine… it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable — or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades.
He gives a great example of a doctor who prescribes epic quantities of a completely discredited drug:
When asked why he continues to prescribe atenolol so frequently in light of the randomized, controlled trials that showed its ineffectiveness, Huynh said, ‘I read a lot of medical magazines, but I didn’t see that.’ Huynh added that his ‘patients are doing fine with it’ and asked that any relevant journal articles be faxed to him.
Best practices can elude the best of us. It’s hard to keep up. Doctors are only human, after all.
There are many quotable passages from this important article. I will share it again, highlighting more.
P.S. Fun detail: as I was reading this, I kept thinking, “This is really good writing. This author is sharp.” And then I realized it’s by the same sharp author of the fantastic book I’m in the middle of: The Sports Gene.