Posterior Neck Pain as the Initial Manifestation of Giant Cell Arteritis: A Diagnostic Challenge

Giant cell arteritis (GCA) is a granulomatous large-vessel vasculitis that typically affects the temporal arteries, presenting with temporal headache, jaw claudication, or visual symptoms. However, not all cases follow the classical pattern. We report a rare case of a 75-year-old woman who presented solely with isolated occipital headache and posterior neck pain, with no temporal tenderness, jaw claudication, or visual complaints. On examination, both temporal arteries were thickened and pulseless. Vascular imaging revealed non-compressible circumferential wall thickening and severe luminal occlusion involving the bilateral superficial temporal main trunks as well as their frontal and parietal branches. This striking dissociation between clinical symptoms and vascular involvement highlights that GCA can silently involve the temporal arteries while presenting atypically, underscoring the importance of considering GCA even when the only symptom is occipital headache.