[Headache from idiopathic cervical artery dissection: time-course and follow-up]

Headache is very common during the acute phase of cervical artery-dissection (CAD) sometimes mimicking a migraine attack. However, the relationships between these two conditions are complex and the course of headache in patients with CAD is not well known. Indeed, migraine is an independent vascular risk factor of stroke, especially ischemic stroke. Recently, a case-control study has shown that migraine is an independent risk factor of CAD. We have studied the course of headache in all consecutive patients hospitalized for spontaneous CAD in our stroke unit between 1998 and 2001, confirmed by a mural hematoma on MRI. We conducted patient interviews with a structured questionnaire about headache (according to the International Headache Society criteria) before and after the CAD. Forty-two patients had had a spontaneous CAD during this period. Twenty-two had had headache in the past: 9 migraine without aura, 5 migraine with aura and 8 with episodic tension-type headache. The headache improved in 22 patients (95.5 percent) after the spontaneous CAD. Of 14 patients who were migrainers, 13 (92 percent) had fewer migraine attacks after the CAD. Only 7 patients, without previous headache developed new headache after CAD: three migraine without aura, three episodic tension-type headache and one chronic tension-type headache. For the majority of patients the pre-existing headache improved after spontaneous CAD. A few patients developed a new headache only after CAD. Relationships between CAD, migraine and elastic tissue disorder should now to be explored.