Headache and Neck Pain: The Warning Symptoms of Vertebral Artery Dissection

Abstract

The clinical features of headache and neck pain in 14 patients with extracranial vertebral artery dissection proven by angiography or magnetic resonance imaging are reported. Pain was always located on the side of the dissected vertebral artery. Whereas eleven patients had head and posterior neck pain, the others had either only posterior neck pain, no change of a chronic pre-existing headache or no pain at all. Pain started suddenly, was of sharp quality and severe intensity, different from any previously experienced headache. Following acute onset, the time course of pain was monophasic with gradual remission of a persistent headache lasting one to three weeks. A delay between onset of head or posterior neck pain and onset of neurologic dysfunction was noted in 12 patients and was less than one day and between one day and three weeks in six each. Report of this distinct type of pain, although nonspecific as an isolated symptom, should raise suspicion of an underlying vertebral artery dissection. Early confirmation of this diagnosis and subsequent anticoagulation if dissection does not extend intracranially may help prevent vertebrobasilar ischemic deficits.

Primary headaches and painful spontaneous cervical artery dissection

“…This agrees with previous studies [4][5][6][7][8]. In ICAD patients, pain was significantly more frequent in the anterior part of the head, compared to VAD, where pain occurred in the nuchal and/or occipital region.…”

“…Headache, facial or neck pain are common presenting symptoms of SCAD, although mechanisms underlying dissection-related pain remains incompletely understood [4][5][6][7][8]. The relationship between previous migraine and painful SCAD was investigated in only two studies with opposite findings and therefore it is still a matter of controversy [4,5].…”

Clinical and Neuroradiological Features of Intracranial Vertebrobasilar Artery Dissection

“…The following data were collected from the medical records of the 31 patients: age and sex, clinical symptoms at onset, headache and/or neck pain, 22 clinical diagnosis including subarachnoid hemorrhage, 2,7 possible dissection-related trauma at onset, type of onset, and clinical course.…”

Early Diagnosis of Vertebral Dissecting Aneurysm: A Magnetic Resonance Angiography Study.

“…However, the patient is treated with an analgesic and observed for a period of time when neurological and hematological examinations are negative in cases presenting with sudden severe headache with nausea or vomiting alone, particularly after excluding cerebral or subarachnoid hemorrhage by brain CT and cerebrospinal fluid examination. In fact, the presence of headache alone without symptomssuggestive of cerebral infarction is inadequate for the diagnosis of intracranial dissecting aneurysm and only a few studies have reported the opposite (5,6). In the present patient, severe headache occurred suddenly, such symptomsthat causes subarachnoid hemorrhage were doubted, without clear symptomsof cerebral infarction or subarachnoid hemorrhage.…”

“…While intracranial dissecting aneurysms underlie less than 1 %of unselected brain ischemic events, they mayaccount for 5%or more of ischemic stroke in young adults without risk factors for cerebrovascular disorders (5). Furthermore, most cases (about 89%) have clinical complications such as cerebral infarction or subarachnoid hemorrhage, however 88% of the patients with intracranial dissecting aneurysm make a good recovery (6,7). Development of a sudden severe headache in the occipital region warrants a complete work-up to exclude dissecting aneurysm of the basilar or vertebral artery, including cerebral angiography (2, 3).…”