When a Trip to the Hair Salon Ends in the Emergency Room

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Getting your hair washed at the salon should be a relaxing experience, but in rare cases a trip to the hairdresser can result in an emergency neurology consult.

Dizziness, weakness, numbness, or a sudden headache following a hair wash could be a sign of beauty parlor stroke syndrome — a vertebral artery stroke resulting from compression of the vessels on the back of the head.

If the hair wash was a prolonged experience and the neck was hyperextended to reach the sink, the “vertebral arteries, most commonly, could get pushed or compressed and decrease blood flow to the brain stem area,” explained Anna Hohler, MD, director of neurology for Northwell Health’s Westchester Region.

It occurs most commonly in older patients, she said, but it can occur in younger patients too, especially if they have problems with their blood vessel connective tissue or have conditions like Ehlers Danlos Syndrome where they’re at risk for blood vessel tearing or dissection. Having high cholesterol or other stroke risk factors also increases risk of beauty parlor stroke syndrome. A literature review published in The American Journal of Emergency Medicine found that most cases occurred in women.

While the condition gets its name from the salon, beauty parlor stroke syndrome can result from many situations, like chiropractic manipulation, whiplash from car accidents, snowboarding and skiing, martial arts, and bungee jumping.

Hohler noted she’s only seen one classic presentation of beauty parlor stroke syndrome as a result of a salon visit in her career, but has more commonly seen it caused by these other circumstances.

It may seem odd that a hair wash and a car crash can result in the same condition, but both can affect the blood vessels of the neck. Hohler said the hair wash would be more of a compression of the vessels while the other higher-intensity scenarios would result in more of a shearing process. Beyond the mechanical triggers, beauty parlor stroke syndrome can result from physiological triggers, like cholesterol buildup, that affect circulation.

As with any sudden-onset neurologic symptoms, it’s best to seek immediate emergency care, Hohler said, which in this case would likely also involve a neurology consultation. Migraines, multiple sclerosis, and other neurologic conditions could present similarly.

“You shouldn’t have any wooziness or dizziness after you’ve been to the hairdresser or the chiropractor, so anytime you’ve had any of those symptoms, it merits an evaluation,” Hohler told MedPage Today.

Beauty parlor stroke syndrome may have a cheeky diagnosis title, but “the brain stem area is actually a very serious area of the brain to have a stroke,” as automatic body functions as well as cognitive, motor, and sensory functions are contained in the brain stem, she said.

The emergency department would do a CT scan of the head with blood vessel imaging, and then an MRI to look at the specific area of stroke. Hohler said that sometimes no treatment beyond getting the head back into a central position is needed to reduce symptoms, but other cases are more complicated.

“If there’s been some type of plaque dislodged in those vessels in the elderly, then those patients may suffer more prolonged symptoms, and they need to have some of the specific stroke treatments,” she explained. This could mean clot-busting drugs, antiplatelet therapy, and aspirin.

Patients could be left with permanent deficits, like changes in balance or coordination, or numbness and weakness, depending on stroke severity. In worse-case scenarios, often when the blood vessel dissection lasted a long time, beauty parlor stroke syndrome can be fatal.

Hohler said that patients who have had beauty parlor stroke syndrome are at risk for recurrence, so she advises them to avoid the activity that produced it.

“In patients who have significant blockage of their vessels in the back of their head from, for example, high cholesterol over the years or other stroke risk factors, they might also have those troubles in their vessels and other parts of the brain,” Hohler said, noting that emergency room assessment and imaging can help clinicians see how widespread the problem is and if the patient carries other stroke risks. These scans may reveal an underlying connective tissue disorder and thus further risk for blood vessel dissections.

Hair salons have increasingly been educated on the risk for beauty parlor stroke syndrome, and some now ask clients if there’s any reason why they can’t extend their neck, and some hair washing stations have been redesigned to reduce neck strain, Hohler said.