Persistent headache attributed to past cervicocephalic artery dissection: clinical characteristics and contributors to headache persistence

Autores da FMUP

• Pedro Miguel Paredes De Abreu

  Autor

• Andreia Filipa Gomes Da Costa

  Autor

Participantes de fora da FMUP

• Martins, BP
• Mesquita, I
• Sousa, JM

Unidades de investigação

• Neurociências Clínicas e Saúde Mental

Abstract

BackgroundPersistent 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. MethodsA 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). ResultsNinety-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. ConclusionHeadache 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.

Keywords

• Cervicocephalic arterial dissection; persistent headache; contributors; secondary headache