If you’ve ever searched online for information about chiropractic neck adjustments, you’ve probably seen warnings about stroke or damage to the arteries in the neck.
That sounds scary. But there’s another part of the conversation that often gets overlooked:
The medications commonly used for neck and back pain aren’t risk-free either.
A large new study published in 2026 gives us some useful perspective.
More Than 860,000 Patients Studied
Researchers compared adults seeking care for a new episode of neck pain or headache.
One group received chiropractic spinal manipulation. The other received medical care that included a prescription for ibuprofen.
After matching the patients to make the groups as similar as possible, researchers compared more than 431,000 people in each group.
During the following 30 days, cervical artery dissection—a rare tear in an artery of the neck—occurred in:
0.007% of the chiropractic group
0.013% of the ibuprofen group
The researchers concluded that they found “no evidence of an increased risk” of cervical artery dissection after chiropractor-administered cervical spinal manipulation compared with patients prescribed ibuprofen.
Why This Matters
One reason this issue has been difficult to study is that neck pain and headache can sometimes be early symptoms of a cervical artery dissection that has already begun.
Imagine someone develops unusual neck pain or a headache and decides to visit a chiropractor. If a vascular problem is diagnosed afterward, it can be easy to assume the adjustment caused it.
But in some cases, the pain that led the person to seek care may have actually been an early symptom of the problem itself.
The authors of the new study specifically discuss this possibility.
Importantly, they also do not claim chiropractic treatment prevents artery dissection. The takeaway is simply that this very large study did not find an increased risk following chiropractic manipulation compared with the ibuprofen group.
Pain Medication Has Risks Too
When someone has neck or back pain, medications such as ibuprofen, naproxen, muscle relaxers and stronger pain medications are commonly used.
These medications can absolutely be helpful. But being common doesn’t mean they’re completely harmless.
A major analysis published in The Lancet reviewed hundreds of randomized clinical trials involving NSAIDs such as ibuprofen and naproxen. Researchers found increased risks of gastrointestinal complications, while some medications and doses were also associated with cardiovascular risks.
Read the NSAID safety research
Kidney health is another consideration.
A study published in JAMA Network Open followed more than 764,000 active-duty U.S. Army members and found that higher prescription NSAID use was associated with modest increases in both acute kidney injury and chronic kidney disease.
Read the JAMA study on NSAIDs and kidney health
That doesn’t mean occasionally taking ibuprofen is dangerous. Dose, frequency, age, medical history and other medications all matter.
It simply means medication should be viewed like any other healthcare treatment: it has potential benefits and potential risks.
What Happens When Chiropractic and Medication Are Compared Directly?
One randomized clinical trial published in Annals of Internal Medicine studied 272 adults with acute or subacute neck pain.
Patients received spinal manipulation, medication, or home exercise with advice.
The spinal manipulation group had better pain outcomes than the medication group at several follow-up points. Researchers also found that 60% of patients in the medication group reported side effects, compared with 40% in the spinal manipulation group.
The manipulation-related complaints were mainly temporary soreness or increased discomfort. Medication-related complaints included drowsiness, gastrointestinal symptoms, dry mouth and cognitive symptoms.
Read the randomized clinical trial
So, Is Chiropractic Safer Than Medication?
That question is a little too simple.
There are hundreds of medications, many chiropractic techniques and many different health conditions. It wouldn’t be accurate to say chiropractic care is always safer than medication—or the other way around.
What the research does show is that medication shouldn’t automatically be considered the risk-free option while chiropractic treatment is viewed as the risky one.
Both deserve a fair look at the evidence.
For many people with uncomplicated musculoskeletal neck or back pain, conservative approaches such as chiropractic care and exercise may provide an option for managing symptoms without automatically relying on medication as the first or only treatment.
The Bottom Line
The newest research involving more than 860,000 patients found no increased risk of cervical artery dissection following chiropractor-administered cervical spinal manipulation compared with patients receiving medical care that included an ibuprofen prescription.
At the same time, medications commonly used for pain have their own well-documented risks.
The goal shouldn’t be “chiropractic versus medicine.”
The goal should be choosing the right treatment for the right patient.
At Davis Family Chiropractic, we evaluate each patient individually to determine whether chiropractic care is appropriate and to watch for signs that may require a different type of care.
If you’re dealing with neck pain, headaches or back pain and want to know whether chiropractic care may be an option for you, contact Davis Family Chiropractic to schedule an evaluation.
This article is for educational purposes and is not intended to diagnose a condition or replace individualized medical advice. Do not start, stop or change a prescription medication without discussing it with your healthcare provider.
