TY - JOUR
T1 - Phenotype of head pain in patients with cervical artery dissection
AU - Wiederkehr, Iris
AU - Tränka, Christopher
AU - Engelter, Stefan
AU - Sprenger, Till
N1 - Funding Information:
Sources of support: CADISP database of the University Hospital of Basel. There is no conflict of interest of the main author. Co-author Prof. Dr. med. Till Sprenger has received research support from: SNF, Novartis, Grünenthal and Swiss MS Society. His employer and previous employer have received compensation for speaking/consulting from: Sanofi, Genzyme, Novartis, ATI, ElectroCore, Mitsubishi Pharma, Actelion, Teva, Biogen Idec.
PY - 2017
Y1 - 2017
N2 - Background and objective: Head and neck pain are key presenting symptoms of cervical artery dissection (CAD) and often preceed other clinical signs or symptoms. CAD is a common cause of stroke and therefore it is important to recognise patients at risk. The aim of this study was a precise description of the clinical features of patients with CAD in order to distinguish CAD from primary and other secondary headache aetiologies. Methods: Medical records of 39 patients previously recruited at the University Hospital of Basel in an observational study (CADISP study) from 2011 to 2015 were reviewed. Telephone interviews were performed to obtain precise descriptions of the clinical features of CAD. Results: Head and neck pain was present in 34 (87%) patients with CAD. Migraine-like symptoms were reported by 32 (82%) patients and trigeminal- autonomic symptoms (including Horner's syndrome) by 27 (69%) patients. The pain onset was variable, including acute development of pain over seconds to minutes in some patients and subacute onset over hours in others. Dynamics of the pain varied between continuous, fluctuating and recurring. Mean pain intensity rated 6 out of 10 on a visual analogue scale. The pain quality was most commonly described as a pressing (36%) or stabbing (28%) sensation. In contrast to other studies, the pain occured most frequently in the occipital region both in internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD). Conclusions: In agreement with prior studies, unilateral and ipislateral pain seems to be the key clinical feature in patients with CAD. The pressing or stabbing quality and the frequent occurance of Horner's syndrome seem to be specific and might help to differentiate CAD from migraine as even aura symptoms occur in CAD. The moderate pain intensity might help to differentiate CAD from primary trigeminal autonomic cephalgias such as cluster headache, which are typically characterised by more severe pain.
AB - Background and objective: Head and neck pain are key presenting symptoms of cervical artery dissection (CAD) and often preceed other clinical signs or symptoms. CAD is a common cause of stroke and therefore it is important to recognise patients at risk. The aim of this study was a precise description of the clinical features of patients with CAD in order to distinguish CAD from primary and other secondary headache aetiologies. Methods: Medical records of 39 patients previously recruited at the University Hospital of Basel in an observational study (CADISP study) from 2011 to 2015 were reviewed. Telephone interviews were performed to obtain precise descriptions of the clinical features of CAD. Results: Head and neck pain was present in 34 (87%) patients with CAD. Migraine-like symptoms were reported by 32 (82%) patients and trigeminal- autonomic symptoms (including Horner's syndrome) by 27 (69%) patients. The pain onset was variable, including acute development of pain over seconds to minutes in some patients and subacute onset over hours in others. Dynamics of the pain varied between continuous, fluctuating and recurring. Mean pain intensity rated 6 out of 10 on a visual analogue scale. The pain quality was most commonly described as a pressing (36%) or stabbing (28%) sensation. In contrast to other studies, the pain occured most frequently in the occipital region both in internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD). Conclusions: In agreement with prior studies, unilateral and ipislateral pain seems to be the key clinical feature in patients with CAD. The pressing or stabbing quality and the frequent occurance of Horner's syndrome seem to be specific and might help to differentiate CAD from migraine as even aura symptoms occur in CAD. The moderate pain intensity might help to differentiate CAD from primary trigeminal autonomic cephalgias such as cluster headache, which are typically characterised by more severe pain.
KW - Cervical artery dissection
KW - Head pain
KW - Headache
KW - Horner's syndrome
KW - Internal carotid artery dissection
KW - Ischaemic stroke
KW - Migraine
KW - Transient ischaemic attacks
KW - Trigeminal-autonomic symptoms
KW - Vertebral artery dissection
UR - http://www.scopus.com/inward/record.url?scp=85039051629&partnerID=8YFLogxK
U2 - 10.4414/sanp.2017.00529
DO - 10.4414/sanp.2017.00529
M3 - Article
AN - SCOPUS:85039051629
SN - 2297-6981
VL - 168
SP - 202
EP - 208
JO - Swiss Archives of Neurology, Psychiatry and Psychotherapy
JF - Swiss Archives of Neurology, Psychiatry and Psychotherapy
IS - 7
ER -
