Any patient who presents to a clinician and complains of neck pain, headache, and/or orofacial symptoms may have a vasculogenic cause of symptoms (although this is rare). All clinicians, irrespective of their training, who are helping patients manage neck pain, headache, and/or facial symptoms must feel confident to identify potential vascular flow limitations of the neck before providing treatment. As you can see from the picture above the Internal and External Carotid feed into the Temporal and Occipital Arteries, all areas where our orofacial pain patients can report pain, headaches, etc.

The recent issue of the Journal of Orthopaedic and Sports Physical Therapy does a great job bringing this important topic to light, Hutting N, Kerry R, Kranenburg R, Mourad F, Taylor A. Assessing Vascular Function in Patients With Neck Pain, Headache, and/or Orofacial Pain: Part of the Job Description of All Physical Therapists. J Orthop Sports Phys Ther. 2021 Sep;51(9):418-421.

In addition, another great resource is the International Framework for Examination of the Cervical Region for potential of vascular pathologies of the neck prior to Orthopaedic Manual Therapy (OMT) Intervention:

Vascular Examination for Clinicians to Consider:

  1. Palpation of the Carotid Pulse: Palpating the carotid involves observing three elements: timing, contour, and amplitude. 
  2. Auscultation of the Carotid: Three common auscultatory findings over the carotid are bruit, the radiated murmur of aortic stenosis, and venous hum from the jugular vein. Patients with carotid bruit occasionally report audible ‘‘buzzing,’’ ‘‘whistling,’’ or ‘‘noise.’’ When listening with a stethoscope a bruit is a blowing, whooshing, or rasping sound heard.


Additionally important ischemic signs of dissection-related events.

  1. Unsteadiness/ataxia: Loss of muscle control, which may lead to imbalance, dyscoordination, and gait disturbance. Ataxia can affect all body regions.
  2. Dysphasia: Impaired ability to produce and understand spoken language.
  3. Dysarthria: Slurred, mumbled, or choppy speech; abnormal speaking speed; or trouble moving the lips, jaw, and tongue.
  4. Aphasia: Speaking in short or incomplete sentences, sentences that don’t make sense, or unrecognizable.
  5. Lower/Upper Limb Weakness: Impaired ability to move or raise the arm or leg.
  6. Ptosis: Drooping or falling of the upper eyelid.
  7. Facial Palsy: Paralysis on one side of the face, which could include droop and difficulty making a facial expression, such as closing an eye or smiling. 


All clinicians who help people with neck pain, headache, and/or orofacial/TMD symptoms should be aware of a potential vasculogenic contribution to the patient’s complaints and assess and refer the patient accordingly.

Michael Karegeannes