Headache secondary to cervical artery dissections: practice pointers

• Published in: Neurological sciences 2019-03, Vol.40 (3), p.613-615
• Main Authors: Gallerini, Simone, Marsili, Luca, Bartalucci, Manuele, Marotti, Caterina, Chiti, Alberto, Marconi, Roberto
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Arteries; Brief Communication; Dissection; Female; Follow-Up Studies; Headache; Headache - etiology; Headaches; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Neurologic Examination; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Pain; Psychiatry; Retrospective Studies; Vertebral Artery Dissection - complications
• ISSN: 1590-1874; 1590-3478
• DOI: 10.1007/s10072-018-3576-y

Cervical artery dissections may present with mild and misleading symptoms such as a headache or cervical pain. In the absence of early diagnosis and therapy, such patients may have a high risk of cerebrovascular events. In order to refine evaluation of cervical artery dissections, we report the experience of a single center, focusing on clinical findings (e.g., headache and pain-related features at onset). From 2012 to 2017, 49 patients with cervical arteries dissections were admitted to our institution; 28 out of 49 patients (57%) presented with a headache or cervical pain, which were evaluated according to the International Classification of Headache Disorders (ICHD-III beta). Item C3a of ICHD-III beta (“pain is severe and continuous for days or longer”) was present in all patients symptomatic for a headache. Another common characteristic was the recent onset, with an average (± SD) timing from the onset of a headache to the first neurologic evaluation of 3 (± 2) days (range 1–5). A refined clinical evaluation of patients presenting with a headache at the Emergency Department could improve the early detection and management of patients with cervical artery dissections, in particular when presenting without other associated neurological symptoms.