"Neurologists have been warning for years of growing evidence that neck manipulation carries a risk of stroke and death from trauma to the neck arteries. Chiropractors have generally denied or minimized this risk. A recent article in the BMJ (British Medical Journal) reviews this controversy and concludes that neck manipulation, based upon relative risk vs benefit, should be abandoned as a therapy…A number of recent systematic reviews of spinal manipulation in general (but including neck manipulation for headaches) have concluded that there is no evidence to support that they are effective for any indication. Looking specifically at cervical manipulation for headaches, systematic reviews are also negative. The reviews indicate that the best controlled studies are negative. The less rigorous studies are mixed. This is a familiar pattern, consistent with an ineffective treatment combined with researcher and publication bias. The BMJ article is actually more favorable, concluding that there is evidence for short term symptomatic benefit from cervical manipulation. However, the evidence shows that the benefits are no better than safer treatments, such as massage, medication, or neck mobilization (a gentler intervention favored by physical therapists)…That is a devastating assessment of any medical intervention, and certainly justifies abandoning that method…Some critics of neck manipulation argue that it should not be abandoned completely but should be reserved for highly selective cases in which there is no contraindication and the safer treatments have been tried and found to be ineffective. This too is reasonable, but is still based upon the notion that neck manipulation has a significant benefit, which has not been established by rigorous clinical evidence. The response of the chiropractic community so far has been predictable. The British Chiropractic Association is quoted by the BBC:

"The cherry-picking of poor quality research needlessly raises alarm in patients and does little to help the people suffering from neck pain and headaches to choose the most appropriate treatment."

As is typical of CAM apologists, they are begging the question - does neck manipulation help those suffering from neck pain? The answer, in my opinion and based on published systematic reviews (the very antithesis of cherry picking) is no. Further, claiming that a reasonable and thorough assessment of risk vs benefit is needlessly alarmist says volumes about the approach of the chiropractic community to their own practice and the scientific evidence. My primary criticism of the CAM community in general, and the chiropractic profession specifically, is that they do not have a culture and philosophy of ethical science-based practice. If they did they would be practicing real medicine, not the "alternative." The issue of neck manipulation and risk of arterial dissection reflects this basic reality, and is not an isolated case but a systemic problem."

Steven Novella, MD, James Randi Educational Foundation's Senior Fellow and Director of the James Randi Educational Foundation’s Science-Based Medicine project. (9th June 2012)