Going to the hair salon, leaning back and having your hair washed and scalp massaged is seen as a great form of relaxation. However, a recent review found that doing so could lead to a life-threatening stroke.

The review — published in the American Journal of Emergency Medicine — analyzed 22 studies documenting 54 cases of beauty parlor stroke syndrome over nearly five decades.

Beauty parlor stroke syndrome (BPSS) refers to the hyperextension that occurs when tilting the head back into a salon shampoo bowl, which can compress or tear the vertebral arteries in the neck that supply blood to the brain. In rare instances, this posture can lead to a stroke.

Researchers found that most affected patients, roughly 80%, were women, with ages ranging from teenagers to seniors. They said symptoms of BPSS include dizziness or vertigo, blurred vision, loss of balance, headache, nausea or vomiting, slurred speech, sudden paralysis or weakness on one side of the body, and more.

Symptoms typically appear during or within several days of the neck being in the triggering position, according to the review.

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“Within the panorama of neurological urgencies, BPSS stands out not only for its unique etiology but also for the commonplace nature of its trigger — neck hyperextension during salon hair washes,” the researchers wrote.

In one case, Elizabeth Smith suffered BPSS in 2014, nearly two weeks after getting her hair done when her neck was “hyper-extended” and resulted in a stroke that has had lasting consequences. She claimed that the hyperextension led her vertebrate to “cut her vertebral artery.” The report said Smith has an “unsteady gait and loss of motor skills in her left hand” in addition to impairment in her left eye.

“I go to sleep wondering, will I wake up tomorrow?” she said at the time.

Health experts note that BPSS is uncommon and largely known from isolated case reports rather than population data. However, some states require precautions to be taken to ensure safety due to the severity.

The Pro Beauty Association in Arizona advises stylists to provide neck support like rolled towels or cushions, and to allow clients to sit more upright during washes, Fox News reports.

Additionally, clients are urged to speak up immediately if they are uncomfortable or experiencing any symptoms like neck strain or dizziness during services.