Doctors are warning about the dangers of neck self-massage, after a patient admitted for a brain stem infarct gave himself a second stroke after attempting to relieve his neck pain.

The massage stimulated the carotoid sinus, triggering a four-second asystole and leading to cerebral hypoperfusion and a subsequent watershed stroke, report doctors from the Maria Hilf clinics in Moenchengladbach, Germany.

The 58-year-old was admitted to the stroke unit after presenting to the ED after waking with right-sided numbness and dysphonia, dysarthria, and difficulty swallowing.

The patient, whose history was unremarkable apart from arterial hypertension (SBP 223 mmHg) was on 100mg aspirin daily (for which the indication was unclear) while his heart rate was 85 beats per minute.