Spontaneous carotid artery dissection presenting as migraine--a diagnosis not to be missed.

Abstract

(fig 1, A and B).He received inpatient anticoagulation and the symptoms resolved within 24 hours. He remained asymptomatic two months later.Case 2 A 27 year old woman had been on an alcoholic binge. The following morning she awoke with a frontal headache and some discomfort in her neck. These symptoms resolved with simple analgesia. The same evening as she was leaning back in her chair extending her neck she suddenly developed paraesthesiae in the left arm and leg. As she got up to walk she limped on her left leg. After two hours she developed a left facial droop and slurred speech. She then attended the A&E department, by which time her symptoms had resolved and a thorough examination was entirely normal.A diagnosis of migraine was made in the A&E department and she was referred to the neurology outpatient clinic. Once again no signs were detected on clinical examination but an MRI scan of the brain and neck showed a dissection of the right internal carotid artery. There were also two areas of infarction in the right cerebral hemisphere. She was admitted, anticoagulated, and subsequently remained well. DiscussionCarotid artery dissection is well described after trauma to the neck and in some cases may occur even after relatively minor injury.' With modern diagnostic techniques it has been recognised more often and is now known to be a common cause of stroke in the young. Our patients could not recall an injury and thus it was presumed that the dissection was spontaneous.

The Link Between Migraine, Reversible Cerebral Vasoconstriction Syndrome and Cervical Artery Dissection

“…However, they are highly variable in terms of onset (progressive, acute, or thunderclap) and topography (often ipsilateral hemicrania in carotid CeAD, ispilateral hemicrania, occipital, diffuse, or anterior headache in vertebral CeAD). Of importance, case reports and cases series have shown that CeAD was able to trigger secondary migraine attacks, particularly with aura. Indeed, in addition to a few cases of attacks suggestive of migraine without aura, numerous cases of migraine attacks with aura or aura without headache have been described at the acute phase of the dissection, both in migraineurs and in individuals without any personal history of migraine .…”

Pain as the only symptom of cervical artery dissection

“…However, it has rarely been reported as the only symptom of sCAD. [7][8][9][10][11][12] Therefore, to determine patterns of pain that could raise suspicion about sCAD, we analysed patients with sCAD, who presented with only headache or neck pain.…”

Spontaneous Carotid Artery Dissection with Cluster-Like Headache

“…Headache is present in 60–80% of cases (7), is ipsilateral to the artery involved in around 2/3 of patients, represents the onset symptom in more than half the cases, and in a minority (around 4%) may remain as the only symptom (8, 9). Although headache is generally aspecific, in some patients it may appear with features similar to primary forms, and in particular to migraine (10–12): 22 patients of a series of 65 with nontraumatic carotid artery dissection suffered from migraine and in 6 of these the onset symptom was a headache with characteristics similar to those of previous attacks (8). Onset of pain is gradual, even though in some cases it may be sudden and violent suggesting subarachnoid haemorrhage (1–7), indeed, ‘thunderclap headache’ has been described in about 10% of a series of 135 patients with spontaneous carotid artery dissection, bringing up problems of differential diagnosis with subarachnoid haemorrhage (9).…”