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Persistent headache attributed to past cervicocephalic artery dissection: clinical characteristics and contributors
Bárbara Pinto Martins1,2, Inês Mesquita2, José Maria Sousa3
1Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.
Insights
Persistent headache after cervicocephalic arterial dissection is common, affecting over 20% of patients long-term. Previous headache history and delayed diagnosis are key contributors to this ongoing pain.
Area of Science:
- Neurology
- Vascular Medicine
- Pain Management
Background:
- Cervicocephalic arterial dissection (CEAD) can lead to persistent head and neck pain.
- The long-term clinical characteristics and contributing factors of this post-dissection pain are not well-documented.
Purpose of the Study:
- To evaluate the clinical features of persistent headache/facial/neck pain following CEAD.
- To identify factors contributing to the persistence of pain after CEAD.
Main Methods:
- Retrospective cohort study of patients with radiologically confirmed CEAD (2015-2020).
- Headache persistence assessed via clinical records and a dedicated questionnaire.
- Analysis included demographics, vascular risk factors, and clinical presentation.
Main Results:
- 26.1% of patients experienced headache persistence for ≥3 months post-CEAD.
- Patients with persistent pain had a higher history of headaches, delayed diagnosis, and presented with headache/neck pain initially.
- Logistic regression identified headache history, acute pain presentation, posterior circulation dissection, and NIH Stroke Scale score as significant contributors.
Conclusions:
- Persistent headache is a common and often daily occurrence after CEAD.
- Identifying contributing factors like prior headache history is crucial for managing patients and improving functional outcomes.
Background:
Persistent headache/facial/neck pain attributed to past cervicocephalic arterial dissection is under-documented in literature. Our main goal was to evaluate clinical characteristics and contributors to this persistence.
Methods:
A retrospective cohort study which included patients with a radiologically confirmed cervicocephalic arterial dissection (2015-2020) in a Portuguese tertiary hospital. Headache persistence was identified through clinical records. A questionnaire aimed to characterize headache in three moments: previous, persistent, and headache at the time of the interview (on average 2.5 years post-event).
Results:
Ninety-two patients were identified; 24 (26.1%) had headache persistence ≥3 months, and 20 (22.2%) on average after 2.5 years post-event. There were no differences regarding demographics and vascular risk factors among patients with (n = 22) and without (n = 68) headache persistence. The first group had higher previous headache history (68.2% vs 4.4%, p < 0.001), delay in diagnosis (3.6 vs 1.9 days, p < 0.001), and headache/cervicalgia as the first symptom (81.8% vs 41.2%, p < 0.001). At the time of the interview, 20% still reported daily headache. A logistic regression model depicted headache history (OR = 59.8, p < 0.001), acute headache/cervicalgia (odds ratio, OR = 25.4, p = 0.005), posterior circulation dissection (OR = 7.6, p < 0.001), and less than 4 points by National Institutes of Health Stroke Scale score (OR = 5.0, p = 0.025) as contributors to headache persistence.
Conclusion:
Headache persistence post-cervicocephalic arterial dissection is common, and frequently affects patients daily. As it potentially affects functional outcomes and quality of life, the contributors identified in this study may help clinicians manage patients after the acute event.
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