Carotid dissection presenting as a prolonged cluster-like headache in a patient with episodic cluster headache

Abstract

We present a patient with known episodic cluster headache, who presented with cluster-like headache in the course of internal carotid artery dissection (ICAD) and discuss possible pathophysiological links between the two diseases. It is well known that cluster-like headache could be the presenting symptom of ICAD. However, ICAD occurring in a patient with a known episodic cluster headache was only once previously described. In the end of the manuscript, we propose red flags to help clinicians differentiate between primary cluster headache and cluster-like attacks masking underlying ICAD. Finally, we raise the question whether at least some proportion of those patients with cluster headache and Horner syndrome previously classified as a primary headache disorder might have been secondary cases to ICAD.

Pain as an alarm signal in cervical carotid dissection: report of a case with catastrophic evolution

“…8,11 Cases of carotid arterial dissection have been misdiagnosed with different headache types, in particular with cluster headache. 2,[13][14][15][16][17][18][19][20][21][22][23][24][25] The detection of Horner syndrome in a patient with a new-onset headache may help promptly diagnose a cervical arterial dissection. 6,26,27 A case of a patient with traumatic internal carotid artery dissection with a clinical picture mimicking hemicrania continua was reported, and this painful entity responded to indomethacin.…”