From the Guidelines
No, turning to the left and forcefully holding or releasing a sneeze will not rupture a healthy carotid artery. While sneezing does temporarily increase pressure in the chest and head, this normal physiological response is not powerful enough to damage a healthy carotid artery 1. The carotid arteries are robust blood vessels designed to withstand normal bodily functions, including sneezing. Some key points to consider:
- Arterial dissections, which can lead to stroke, are often caused by significant head and neck trauma, but about half occur spontaneously or after a trivial injury 1.
- Certain underlying connective tissue disorders, such as fibromuscular dysplasia, Marfan syndrome, and Ehlers-Danlos syndrome, can increase the risk of spontaneous dissection 1.
- However, sneezing is not typically considered a risk factor for carotid artery rupture, and there is no evidence to suggest that turning to the left or holding a sneeze would increase this risk. It's essential to note that if you have a pre-existing vascular weakness or abnormality, you should consult with your healthcare provider for personalized advice on managing sneezing and other bodily functions. In general, it's best to let sneezes happen naturally, covering your mouth and nose with a tissue or the inside of your elbow to prevent spreading germs. If you frequently feel the need to suppress sneezes, understand that occasionally doing so poses minimal risk, but repeatedly suppressing sneezes could potentially cause minor issues like ear pain or rarely, small blood vessels breaking in the eyes or nose.
From the Research
Carotid Artery Rupture and Sneezing
- There is no direct evidence to suggest that turning to the left and forcefully holding a sneeze or sneezing forcefully can rupture the carotid artery 2.
- However, it is known that active intervention to limit a sneeze can be deleterious, and closure of the airway during a sneeze can result in over 20 times the airway pressures, leading to various untoward events 2.
- A review of sneeze-related injuries found that a variety of injuries can occur during a sneeze, especially when a closed-airway sneeze is attempted, and high Valsalva pressure is transmitted to other systems 2.
- The carotid arteries are prone to rupture in certain individuals, such as those with head and neck cancer, excessive weight loss, reduced haemoglobin, nutritional deficiencies, cardiovascular or renal disease, or endocrine disorders 3.
- High blood pressure is also an important risk factor for atherosclerosis, the development of unstable carotid plaques, and ischemic strokes 4.
- Plaque rupture is a determinant of vascular events in carotid artery atherosclerotic disease, and matrix metalloproteinases 2 and 9 are involved in the progression of atherosclerosis and plaque rupture 5.
Risk Factors for Carotid Artery Rupture
- Patients with head and neck cancer who are over 50 years of age with excessive weight loss and reduced haemoglobin have a greater risk of carotid artery damage leading to rupture 3.
- Those with existing nutritional deficiencies, cardiovascular or renal disease, or endocrine disorders also have a higher risk of carotid artery rupture 3.
- High blood pressure is an important risk factor for atherosclerosis, the development of unstable carotid plaques, and ischemic strokes 4.
- Men are more at risk for sneeze-related injuries, with the majority occurring in patients with no known risk factor 2.
Prevention and Management
- Prevention of carotid artery rupture includes improving nutritional status, preventing infection and constipation, promoting healing, and using safe suctioning 3.
- Intensive medical treatment, including blood pressure lowering medication, reduces the risk of both primary and secondary vascular events in patients at risk 4.
- Carotid intervention for symptomatic high-grade carotid stenosis is best managed with intervention either by carotid endarterectomy or carotid stenting 6.