Department of Neurology, Cerrahpasa School of Medicine, İstanbul University, Istanbul, Turkey.
Department of Neurology, School of Medicine, Akdeniz University, Antalya, Turkey.
Acta Neurol Belg. 2021 Oct;121(5):1173-1178. doi: 10.1007/s13760-021-01674-6. Epub 2021 Apr 23.
Headache is a common symptom of cervical artery dissections (CAD). Sometimes, it can be the only symptom and mimic migraine. We aimed to investigate headache characteristics and previous history of migraine in CAD patients, and to compare headache features between patients with internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD). We investigated 53 CAD patients (n = 28 with ICAD, n = 25 with VAD). Demographic and clinical data were evaluated retrospectively. Headache information was obtained from the patient interviews with a structured questionnaire (based on the International Headache Society criteria). The patients with headache were assessed by headache specialist with a face-to-face interview. Headache was evaluated according to International Classification Committee of the International Headache Society ICHD. Headache (n = 38, 71.7%) was the most common symptom in CAD patients, which was mostly thunderclap, throbbing, intense and ipsilateral to dissection. Headache frequency and neck pain were significantly higher in VAD patients (p = 0.002, p < 0.001, respectively). Photophobia and phonophobia were also more common in patients with VAD (p < 0.001, p < 0.001, respectively). 29 (54.7%) of CAD patients had a prior history of headache, that 20 (37.7%) of them met the migraine criteria. CAD should be considered in patients with severe unilateral throbbing headache with phonophobia and photophobia, even in patients with a history of migraine. Phonophobia and photophobia may be more common symptoms in VAD patients. Because headache commonly precedes the development of cerebral ischemic events, it needs prompt and accurate diagnosis and treatment.
头痛是颈内动脉夹层（CAD）的常见症状。有时，它可能是唯一的症状，并模拟偏头痛。我们旨在研究 CAD 患者头痛的特征和偏头痛的既往病史，并比较颈内动脉夹层（ICAD）和椎动脉夹层（VAD）患者的头痛特征。我们调查了 53 例 CAD 患者（ICAD 患者 28 例，VAD 患者 25 例）。回顾性评估了人口统计学和临床数据。通过结构化问卷（基于国际头痛协会标准）从患者访谈中获取头痛信息。由头痛专家通过面对面访谈对有头痛的患者进行评估。根据国际头痛协会分类委员会 ICHD 对头痛进行评估。头痛（n=38，71.7%）是 CAD 患者最常见的症状，主要是霹雳样头痛、搏动性头痛、剧烈头痛和同侧头痛。VAD 患者的头痛发作频率和颈部疼痛明显更高（p=0.002，p<0.001）。畏光和畏声在 VAD 患者中也更为常见（p<0.001，p<0.001）。29 例（54.7%）CAD 患者有头痛既往史，其中 20 例（37.7%）符合偏头痛标准。对于有严重单侧搏动性头痛、畏声和畏光的患者，即使有偏头痛病史，也应考虑 CAD。VAD 患者可能更常见的症状是畏声和畏光。由于头痛通常先于脑缺血事件的发生，因此需要及时准确的诊断和治疗。
