Headache Attributed to Cranial or Cervical Vascular Disorders

Abstract

Cranial or cervical vascular disease is commonly associated with headaches. The descriptions may range from a thunderclap onset of a subarachnoid hemorrhage to a phenotype similar to tension type headache. Occasionally, this may be the sole manifestation of a potentially serious underlying disorder like vasculitis. A high index of clinical suspicion is necessary to diagnose the disorder. Prompt recognition and treatment is usually needed for many conditions to avoid permanent sequelae that result in disability. Treatments for many conditions remain challenging and are frequently controversial due to paucity of well controlled studies. This is a review of the recent advances that have been made in the diagnosis or management of these secondary headaches.

Pain Manifestations of COVID-19 and Their Association With Mortality: A Multicenter Prospective Observational Study

“…Headaches may result from numerous causes, including myofascial pathology, psychological stress, and vascular pathology (eg, temporal arteritis, microbleeds, thromboembolic disease, vasospasm, and dilation), all of which are common with COVID-19 infection. [16][17][18] The prevalence of pain in our study was 38.5% (65 of 169) among patients admitted with COVID-19 infection to WMC and SNU, which is significantly higher than other studies that have examined clinical symptoms in COVID-19 infection. In a retrospective study performed in 99 patients admitted to a Wuhan, China, hospital with active disease, 11% reported myalgias; 8%, headache; 2%, chest pain; and 3%, gastrointestinal symptoms, though the proportion with abdominal pain was not noted.…”

Secondary Headache: Current Update

“…Daily high‐dose systemic glucocorticoids are the first‐line therapy for GCA for the preservation of vision and treatment of other clinical symptoms associated with GCA, including headache, which subsides promptly with the initiation of therapy 36 . Steroid‐sparing agents, such as methotrexate and tocilizumab, should be considered in patients with pre‐existing medical conditions, such as osteoporosis and diabetes, which may be exacerbated with high‐dose steroids 37 .…”

“…[29][30][31] The inflammation of cranial arteries, especially branches of the external carotid artery, contribute to headache in GCA. 32 Headache attributed to GCA requires evidence of causation as demonstrated by a close temporal relation to other symptoms and/or signs of GCA, and either parallel worsening with GCA or significant improvement within 3 days of high-dose steroid treatment. 2 According to the American College of Rheumatology, 3 of the following 5 primary features are required to meet the diagnostic criteria of GCA: (1) ESR > 50 mm/hour; (2) age ≥ 50 years; (3) new-onset of headache; (4) clinical temporal artery abnormality; and (5) abnormalities on temporal artery biopsy.…”

Manual therapy and cervical artery dysfunction: Identification of potential risk factors in clinical encounters

“…Headaches experienced by the patient are typically unilateral and in the frontotemporal region, although they can present in the occipital region. 30,34 Patients may characterise these headaches as a constant steady ache, throbbing or sharp, and importantly, their pain is commonly described as unlike anything they have experienced previously. Symptoms suggesting cranial nerve involvement have…”