How a trip to the hairdresser can turn into a health emergency

Independent

14-02-2025

Going to the hairdresser is often considered a relaxing, pampering experience, but a rare condition known as beauty parlour stroke syndrome (BPSS) can, for a small number of people, make a shampoo at the hairdresser's a serious health threat.
How could a trip to the hairdresser turn into a health emergency? Research suggests that sitting at an awkward angle at the backwash basins used for hair washing in many salons can cause neck pain, injury and – on very rare occasions – even a life-threatening stroke.
BPSS was first identified in 1993 by American neurologist, Michael Weintraub, who found that some of his patients had developed severe stroke-related symptoms after having their hair shampooed during a visit to a hairdresser.
A stroke is a brain attack caused by a sudden reduction in blood flow to the brain. It's usually caused by a blockage from a blood clot – or the tearing and bursting of a major blood vessel in the brain – leading to a reduction of oxygen, glucose and nutrients that damages and kills brain cells.
During the shampooing process, clients are usually asked to sit down and hang their head back over the edge of the washbasin. Research suggests that overextending the head and neck over the rigid rim of the sink is the primary cause of BPSS.
The unusual neck position, neck rotation or sudden jerking movements during vigorous shampooing can cause the backbones of the higher spinal column around the neck area to push against one of the major blood vessels that supply blood to the back and bottom of the brain. Some cases of BPSS have also been caused by bone spurs – tiny bone fragments from lumps on the spine – that can either compress or tear the artery next to them.
Strokes are often associated with older people and those with medical issues such as high blood pressure, diabetes or high cholesterol – but young, healthy people can have strokes too. While research suggests BPSS is most likely to occur in women over 50 – and previous history of narrowing or thinning of blood vessels and arthritis of the spinal column in the neck are particular risk factors – it could happen to anyone regardless of age or medical history.
A 2016 Swiss study found only 10 instances of BPSS during 2002-2013 so, although BPSS is much rarer than conventional stroke, it's still important to be aware of the symptoms. So, what should you look out for?
Signs of BPSS include headache, lightheadedness, dizziness, blurred or narrowed vision, nausea, vomiting, pain in the neck and some paralysis on one side of the body – some patients also report a near loss of consciousness. Studies suggest that these symptoms may be delayed, making it difficult for doctors to diagnose BPSS rather than a conventional stroke.
Precautions
If you're worried about BPSS or experience pain and discomfort when using a backwash sink, ask to lean forward over the sink rather than extending your head backwards over the rim of the basin. If it is not possible to avoid a backwash at the salon, ask for neck support during hair washing.
The speed at which the hair is washed, how long it takes and any force or jerking movement to the head and neck while washing all contribute to the risk. Request a gentle wash, try not to stay in position at the backwash longer than you have to and inform your hairdresser if you experience any discomfort during washing.
Hairdresser shampooing is a generally safe and enjoyable activity for most people. For the most part, going to the hairdresser is important for mental health, self-esteem and confidence. So let's not throw in the hair towel just yet – use it as a neck support while we're being pampered instead.
Maria Ashioti is a senior lecturer in Neuroscience, Inflammatory Disorders and Therapeutics at the University of Westminster.