---
title: "Needling the neck"
url: "https://acuiq.com/wiki/safety/needling-the-neck"
updated: 2026-10-13
last_verified: 2026-10-13
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "safety"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-13"
reading_minutes: 8
sources: 7
---

# Needling the neck

_What the WHO guidelines and case reports from China, Japan and Korea record about needles reaching the brainstem, the cervical cord, the carotid artery and the trachea, and how deep imaging studies found those structures._

Three structures in the neck lie within reach of an acupuncture needle: the medulla oblongata, the lowest part of the brainstem, which joins the spinal cord just below the skull at the back of the neck; the carotid artery, the main artery to the head, at the side of the throat; and the trachea, the windpipe, behind the notch at the top of the breastbone. Safety guidance names the points over each of them, case reports from China, Japan and Korea describe what happened when a needle reached them, and imaging studies have measured how far below the skin they lie. This page reports those three kinds of source. Injuries to the lung at the base of the neck and above the collarbone are on [Needling over the chest](/wiki/safety/needling-over-the-chest).

## What the WHO guidelines name

The WHO’s 1999 [Guidelines on basic training and safety in acupuncture](https://iris.who.int/handle/10665/66007) state that inappropriate manipulation at points between or beside the upper cervical vertebrae, naming [`GV15`](/points/gv15) (Yamen) and [`GV16`](/points/gv16) (Fengfu), may puncture the medulla oblongata. The symptoms they list are headache, nausea, vomiting, sudden slowing of breathing and disorientation, followed by convulsions, paralysis or coma. Lower down, between the vertebrae above the first lumbar, they warn that too deep a needle may puncture the spinal cord, causing lightning pain in the limbs or the trunk below the level of the puncture.

The same section lists further points as potentially dangerous, requiring special skill and experience: [`CV22`](/points/cv22) (Tiantu), in front of the trachea, and [`ST09`](/points/st09) (Renying), near the carotid artery, alongside points near the eye, the femoral artery and the radial artery. The guidelines’ list of points to be taught marks GV15, GV16 and CV22 among the seven that need that skill. They do not name [`GB20`](/points/gb20) (Fengchi), which the case reports below do.

## The back of the neck

A [2010 systematic review](https://pmc.ncbi.nlm.nih.gov/articles/PMC2995190/) by Zhang and colleagues, Edzard Ernst among them, read the Chinese-language case reports and case series published from 1980 to 2009 and found 35 cases of subarachnoid haemorrhage after acupuncture, bleeding into the fluid-filled space that surrounds the brain and spinal cord. Three of the patients died. One had a history of hypertension and cerebral haemorrhage and died 10 days after treatment; the other two died within 30 minutes, which the reviewers suggest may have resulted from injury to the medulla oblongata. The rest recovered after 1 to 8 weeks of treatment. The review also counted 9 spinal epidural haematomas, collections of blood outside the membrane that covers the cord, with no further detail.

The points most often involved in these bleeds were GB20, GV15, GV16, [`GV14`](/points/gv14) (Dazhui) and [`BL10`](/points/bl10) (Tianzhu), and in several cases the needles had gone 4 to 5 cm below the skin, which the reviewers suspect caused the injury. One of the reports in the review’s table describes bleeding into the cisterna magna, the pool of cerebrospinal fluid between the cerebellum and the back of the medulla.

Reports from Japan add a second route: a needle left in the neck. A [2010 review](https://doi.org/10.1016/j.wneu.2010.03.020) by Miyamoto and colleagues, neurosurgeons in Tokyo, notes that some acupuncturists still embed whole needles deep in the tissue on purpose and that some patients needle themselves. It gathered 26 patients with cervical cord or brain injuries from acupuncture needles, their own case included: 15 from deliberately embedded needles, 11 from needles that broke by accident, and 5 from self-acupuncture. Sixteen of the 26 developed symptoms more than 30 days after the needle went in. Twenty-one had the needle removed surgically, 10 of whom showed signs of recovery, and none of those treated without surgery improved. In their own patient a needle broken off during self-acupuncture lay in the medulla oblongata and the cerebellum and moved further into the brain over a few days. A [1990 case report](https://doi.org/10.2176/nmc.30.956) by Murata and colleagues describes a woman of 33 with sudden severe headache at the back of the head, whose X-ray showed a gold needle about 1.5 cm long between the first and second cervical vertebrae, buried about 30 years earlier; it had pierced a spinal nerve root and caused a subarachnoid haemorrhage. [Broken and retained needles](/wiki/safety/broken-and-retained-needles) covers retained needles elsewhere in the body.

From Korea, a neurosurgeon in Seoul [reported in 2025](https://pmc.ncbi.nlm.nih.gov/articles/PMC12599455/) two women, aged 35 and 48, who felt an abrupt and intense pain as a needle entered the neck and then developed tingling and weakness in the left arm. MRI within 3 hours showed a lesion in the cervical cord, at the level of the fourth to sixth vertebrae. He writes that in both, and in two earlier Korean cases, the needle went in perpendicular to the skin, possibly aimed at the EX-B2 points. The weakness improved in both women; at 2 years and at 2 months respectively, the painful tingling had not improved without medication.

## How deep the dura and the vessels lie

A [2015 MRI study](https://pmc.ncbi.nlm.nih.gov/articles/PMC4521547/) by Chou and colleagues at a medical centre in Taiwan measured 11 neck and shoulder points on the existing scans of 394 patients, along a line perpendicular to the skin. For GV15 and GV16 it measured the distance from the skin to the dura, the outer membrane around the brainstem and cord; for GB20 and ST09 to the outer wall of a major vessel such as the internal jugular vein or the common carotid artery.

| Point | Structure measured to | All 394 | BMI under 18.5 | BMI 25 or over |
| --- | --- | --- | --- | --- |
| GV15 | Dura | 4.9 | 3.9 | 5.5 |
| GV16 | Dura | 4.6 | 3.6 | 5.2 |
| GB20 | Major vessel | 5.0 | 4.3 | 5.6 |
| ST09 | Major vessel | 1.6 | 1.2 | 1.9 |

Body mass index (BMI) is weight in kilograms divided by the square of height in metres. The depth at every point rose with BMI, and men measured deeper than women at most points, though not consistently at ST09. The authors note that there is no agreed definition of a dangerous, safe or therapeutic depth, that they could not analyse age, and that they measured only a perpendicular needle, whereas a different angle gives a different depth.

A [2024 study](https://pmc.ncbi.nlm.nih.gov/articles/PMC11034117/) by Tang and colleagues took a different approach on 29 dry skulls, 197 cervical vertebrae and the X-rays of 31 patients in China, asking whether bony landmarks can be used to judge a safe depth on the midline at the back of the neck. The authors place GV16 between the skull and the first cervical vertebra, the atlas, and GV15 between the atlas and the second. On the dry atlases, the bone from the tip of the posterior tubercle to the spinal canal measured a mean of 6.6 mm along its upper border. The authors cite a textbook depth of 0.5 to 1 cun on this midline, a cun being about 2 cm in their source. The mean length of the second vertebra’s spinous process along its upper border exceeded that depth at GV15 and GV16, but the shortest they measured fell below it, and they say practitioners should pay attention to the difference.

## The front of the neck

The Zhang review found 6 injuries in the neck region: 4 to nerves, 1 false aneurysm of the carotid artery, a bulge formed where blood leaks through a damaged arterial wall, and 1 bleed into the thyroid. One patient died after needling at CV22, where the needle had been inserted to a depth of 6 cm; the review’s table records an injury to the inferior laryngeal nerve and the trachea. A needle at [`LI18`](/points/li18) (Futu) was followed by paralysis of a vocal cord and air under the skin. CV22 also appears among the points in the review’s pneumothorax cases, which [Needling over the chest](/wiki/safety/needling-over-the-chest) reports.

In the Chou study ST09 was the shallowest of the neck points it measured to a vessel, apart from LI18 at 1.3 cm. The authors write that the external jugular vein near these points can be avoided by careful inspection, and that the internal jugular vein and the common carotid artery are the main structures to avoid.

Fainting is the other event the Zhang review ties to the neck. In one report of 82 cases, 49 patients fainted during their first treatment, and 83% of those 49 fainted while the head or neck was being needled. [Fainting during treatment](/wiki/safety/fainting-during-treatment) covers it in full.

## What the sources cannot tell you

The case reports record injuries that someone chose to publish, without the number of people needled at the same points, so they give no rate. The Chinese reports are published only in Chinese, and for some events, the spinal epidural haematomas among them, the review had no detail to give. The MRI study is retrospective and comes from one hospital in Taiwan; the bone study used specimens of unknown sex. AcuiQ’s point pages print the cautions their sources gave and no depth for any point, for the reasons [Reading a point warning](/wiki/safety/reading-a-point-warning) sets out.

### Sources

1. World Health Organization, Guidelines on basic training and safety in acupuncture, 1999 — https://iris.who.int/handle/10665/66007
2. Zhang J, Shang H, Gao X, Ernst E, Acupuncture-related adverse events: a systematic review of the Chinese literature, Bulletin of the World Health Organization 2010 — https://pmc.ncbi.nlm.nih.gov/articles/PMC2995190/
3. Miyamoto S, Ide T, Takemura N, Risks and causes of cervical cord and medulla oblongata injuries due to acupuncture, World Neurosurgery 2010 — https://doi.org/10.1016/j.wneu.2010.03.020
4. Murata K, Nishio A, Nishikawa M, Ohinata Y, Sakaguchi M, Nishimura S, Subarachnoid hemorrhage and spinal root injury caused by acupuncture needle: case report, Neurologia Medico-Chirurgica 1990 — https://doi.org/10.2176/nmc.30.956
5. Kim MS, Cervical spinal cord injury due to direct needle damage during acupuncture, Korean Journal of Neurotrauma 2025 — https://pmc.ncbi.nlm.nih.gov/articles/PMC12599455/
6. Chou PC, Huang YC, Hsueh CJ, Lin JG, Chu HY, Retrospective study using MRI to measure depths of acupuncture points in neck and shoulder region, BMJ Open 2015 — https://pmc.ncbi.nlm.nih.gov/articles/PMC4521547/
7. Tang Z, Liu J, Li J, Ma C, Use of bone landmarks for assessing the safety of acupuncture on the posterior midline of the neck region, BMC Complementary Medicine and Therapies 2024 — https://pmc.ncbi.nlm.nih.gov/articles/PMC11034117/