What's 'beauty parlour stroke syndrome' that caused Indian woman's death? How can one avoid it?

Can one suffer a stroke while getting their hair washed at a salon? Turns out it is a possibility. A woman in Hyderabad, the capital of the southern Indian state of Telangana, reportedly died of a stroke after she got her hair shampooed at a salon.

According to doctors, the woman could have suffered a 'beauty parlour stroke syndrome' or vertebrobasilar insufficiency where bending the neck over a hard sink can lead to tearing of arteries, blood clots and strokes.

Dr Sudhir Kumar, senior consultant neurologist, Apollo Hospital, Jubilee Hills, Hyderabad took to Twitter recently to report the incident and said the woman showed dizziness, nausea and vomiting symptoms initially, “which started during her hair wash with shampoo in a beauty parlour”.

She was “initially taken to a gastroenterologist, who treated her symptomatically”.

Beauty Parlor #Stroke Syndrome

1. I recently saw a 50-year old woman with symptoms of dizziness, nausea & vomiting, which started during her hair wash with shampoo in a beauty parlor. Initially, she was taken to a gastroenterologist, who treated her symptomatically.#Medtwitter — Dr Sudhir Kumar MD DM🇮🇳 (@hyderabaddoctor) October 30, 2022

However, the expert noted that her symptoms did not improve, and the next day woman developed a mild imbalance while walking. “She was referred for my opinion. She had mild right cerebellar signs. MRI brain revealed infarctin the right posterior inferior cerebellar territory, MR angiogram showed left vertebral hypoplasia," he said.

The woman was eventually diagnosed with 'beauty parlour stroke syndrome.'

“A possible mechanism is kinking of the vertebral artery during hyperextension and turning of the neck towards the wash basin while washing hair with shampoo. She had well-controlled hypertension too,” the doctor added.

What is Beauty Parlour Stroke Syndrome?

The term was first coined by Michael Weintraub in 1993, in the Journal of American Medical Association after observing stroke symptoms in two elderly women after shampoo treatment in a beauty parlour. Salons across the world, typically bend the client's neck backwards while seated on a chair, resting the nape of the neck on the sink in order to wash their hair.

Medically known as Vertebro-basilar insufficiency, the disorder is also referred to as Salon Sink Syndrome and Salon Wash-basin Syndrome.
In 2016, The Guardian reported about a case where a man was paid compensation after he collapsed two days after getting his haircut at a salon in Brighton, UK.

Symptoms of this syndrome can include severe dizziness, loss of balance and facial numbness. The body part which is under the control of the brain part that does not get oxygen also suffers damage. Not just women, but men too can suffer from this syndrome especially those who go for neck messages.

However, Dr Kumar noted that stroke affecting vertebro-basilar artery territory can occur during shampoo hair-wash in a beauty parlour, especially in women with other atherosclerotic risk factors and undetected vertebral hypoplasia. “Prompt recognition and treatment can prevent disability," he added.

Should one stop getting a hair wash at salons?

When asked what people can do to avoid such a stroke, Dr Sudhir Kumar said, “Women don’t have to stop going to parlours or washing their hair there! They can avoid keeping their necks in an awkward hyperextension. Or they can use a towel or for support instead of completely extending their necks. Sometimes these procedures can go on for 30 to 35 minutes, so that can be shortened.”

In an interview to Self Magazine, Aneesh Singhal, MD, associate professor of neurology at Harvard Medical School and vice chair of Neurology at Massachusetts General Hospital noted that this type of stroke is not only restricted to hair wash or neck message at salons but can also occur to people when they’re at the dentist, playing tennis, undergoing chiropractic neck manipulation, and even while doing yoga.

Singhal states that salonvisits need not be curtailed but he advised avoiding "activities where the neck would be malpositioned for a long period of time—more than 10 or 15 minutes, but it could be even less."