The purported causal link between cervical chiropractic manipulation and vertebral artery dissection leading to stroke remains a contentious topic across legal, medical, and consumer spheres. However, extensive population data and biomechanical analyses continue to refute a direct causal mechanism, suggesting instead that patients in the prodromal stages of an evolving dissection frequently seek chiropractic care for relief. Early dissection symptoms typically manifest as acute neck pain and headache, closely resembling everyday musculoskeletal complaints. Large-scale cardiovascular research demonstrates that ischemic stroke risk peaks sharply within the initial two weeks following a spontaneous dissection event. When evaluating adverse vascular events, establishing a rigorous chronological timeline is paramount. If a patient presented with new or unusual head and neck pain prior to receiving manual therapy, the vascular dissection was almost certainly already underway before treatment occurred. Researchers, attorneys, and clinicians must meticulously reconstruct symptom onset dates rather than assuming the adjustment triggered the stroke simply because it preceded it. Acknowledging this biological timeline reframes temporal associations, underscoring that cervical adjustments are often coincidental encounters during an unfolding vascular crisis.