OBJECTIVE

To discuss the case of a patient with chronic headache. Although not in severe pain at time of consultation, signs and symptoms raised concern. The patient later had a cerebrovascular accident.

METHODS

A 49-year-old man with non-traumatic chronic episodic head and neck pain presented for care. Examination and plain film radiographs were unremarkable, suggesting a mechanical origin for the symptoms; however, information in the case history raised concerns.

RESULTS

The patient was examined and not manipulated by the doctor of chiropractic but referred back to his general practitioner for a second opinion. The following week, the patient was admitted to hospital having had a cerebrovascular accident.

CONCLUSIONS

The possible indication of the prodrome to a stroke may lie in the case history rather than the examination findings and provocative testing.