Headache in cervicocerebral artery dissection
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HEADACHES AND CEREBROVASCULAR DISEASE
Headache in cervicocerebral artery dissection Simone Vidale 1
# Fondazione Società Italiana di Neurologia 2020
Abstract Cervicocerebral artery dissection (CAD) is one of the more frequent causes of stroke in young adults with rates of up to 25%. Predisposing and risk factors for CAD are very different, and an etiological classification is based on the presence of a previous minor or major trauma, differentiating traumatic from spontaneous CAD. Headache represents one of the main initial symptoms for this pathological condition, probably due to the release of pro-inflammatory neurotransmitters from nerve terminals near the injured vessel. For its peculiar characteristics, the headache due to CAD has been defined with specific ICHD-3 criteria. In many cases, headache is associated with other signs related to the dissection or cerebral ischemia. In this systematic review of literature, headache was reported in more than 70% of cases with CAD with a prevalence in vertebrobasilar dissections. More than half of patients suffered a severe pain that was usually located in fronto-temporal and occipito-nuchal regions in the case of dissections in the anterior and posterior circulation, respectively. For the high stroke risk, CAD has to be promptly diagnosed with MRI or CTA and treated with anticoagulants or antithrombotics. Keywords Headache . Migraine . Cervical artery . Intracranial artery . Dissection
Introduction Cervicocerebral artery dissection (CAD) is one of the leading causes of stroke in young adults [1–3]. Miller Fisher reported the first description of this pathological condition in the 1970s [4]. Dissections refer to a tear in the wall of an artery located in an extra- or intracranial site. CAD is classified based on artery involvement (carotid and vertebral) and the location of the involvement (intracranial or extracranial/cervical). It is considered as a cervical artery dissection when this injury occurs in the internal carotid or vertebral artery, outside the skull. When the primary dissection is located above the petrous bone, it is referred to as an intracranial dissection. Previous reports showed that about 2% of all ischemic stroke patients was affected by CAD, but this rate increases if young age is considered (up to 25%) [5]. In this population, the annual incidence rate is 2.6 to 2.9 per 100.000 [6]. However, the true Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10072-020-04651-8) contains supplementary material, which is available to authorized users. * Simone Vidale [email protected] 1
Department of Neurology, Infermi Hospital, Viale Luigi Settembrini, Rimini, Italy
incidence of this pathological condition may be higher because of an underdiagnosed CAD. Overall, in previous studies, the median age of occurrence is 45 years with a slight prevalence for males.
Pathophysiology and risk factors for CAD As previously reported, the arterial dissections are secondary to a tear in the layers of the arter
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