Journal of Neurology

, Volume 266, Issue 2, pp 298–305 | Cite as

Characteristics and relative factors of headache caused by cervicocerebral artery dissection

  • Yuhan Wang
  • Wenchao Cheng
  • Yajun LianEmail author
  • Jing ZhangEmail author
  • Yake Zheng
  • Yiying Hu
  • Yuan Chen
  • Shouyi Wu
  • Zhi Huang
  • Yinping Shi
Original Communication



To analyze the characteristics and relative factors of headache and neck pain due to cervicocerebral artery dissection (CAD).


A total of 146 consecutive patients with CAD in Zhengzhou, China (2010–2017) were observed and registered prospectively. There were 60 (60/146) cases who complained of headache and neck pain, and we analyzed the characteristics of pain according to their clinical features. For the 130 (130/146) patients with complete clinical laboratory data, they were divided into two groups according to pain, and the relative factors of pain were analyzed.


The headache and neck pain in 60 CAD patients was mostly acute onset (98.3%), 70.6% (12/17) of patients with anterior circulation dissection and 88.4% (38/43) of patients with posterior circulation dissection complained of moderate to severe pain. 41.2% (7/17) of patients with anterior circulation dissection had temporal pain, while 46.5% (20/43) of the patients with posterior circulation dissection had occipital pain. There were 23.5% (4/17) and 32.6% (14/43) of patients with anterior and posterior circulation dissection complained of throbbing pain, respectively, 23.5% (4/17) and 20.9% (9/43) of patients with anterior and posterior circulation dissection complained of pulsating pain. The pain could occur in the ipsilateral (40.0%), bilateral (52.7%), or contralateral (7.3%) sites of the dissection. In the 130 patients, there were 56 cases (43.1%) in the pain group, and 74 cases (56.9%) in the non-pain group. Multivariate logistic regression analysis showed that female gender (OR 4.01, 95% CI 1.63–9.85, P = 0.002), posterior circulation (OR 3.18, 95% CI 1.39–7.28, P = 0.006), history of headache (OR 4.72, 95% CI 1.08–20.52, P = 0.039), and low-density lipoprotein less than 1.8 mmol/L (OR 2.90, 95% CI 1.15–7.34, P = 0.025) were risk factors of the occurrence of the pain related to CAD.


The headache and neck pain caused by CAD is a moderate to severe pain occurring suddenly. The pain nature may be diverse but mostly like throbbing and pulsating. When the dissected artery is located in the posterior circulation, the pain is mostly in the occipital region, and mostly in the temporal region when the dissected artery is located in the anterior circulation. The pain can occur in ipsilateral, bilateral, or contralateral of the dissection. In addition, several factors might contribute to the occurrence of headache and neck pain.


Cervicocerebral artery dissection Headache and neck pain Pain features Relative factors 



The authors thank the patients for their collaboration.


This study was supported by the grant from National Natural Science Foundation of China [no. 81771397]; The National Natural Science Foundation of China, Youth Science Foundation Project [no. 81701271].

Compliance with ethical standards

Conflicts of interest

The authors declare that there is no conflict of interest.

Ethical approval

The Ethics Committee of the First Affiliated Hospital of Zhengzhou University approved this study (Number: KW-2018-LW-006).

Informed consent

All subjects gave their informed consent prior to their inclusion in the study.

Supplementary material

415_2018_9111_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 15 KB)


  1. 1.
    Putaala J, Metso AJ, Metso TM, Konkola N, Kraemer Y, Haapaniemi E et al (2009) Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki young stroke registry. Stroke 40:1195–1203. CrossRefGoogle Scholar
  2. 2.
    Leys D, Bandu L, Henon H, Lucas C, Mounier-Vehier F, Rondepierre P et al (2002) Clinical outcome in 287 consecutive young adults (15 to 45 years) with ischemic stroke. Neurology 59:26–33. CrossRefGoogle Scholar
  3. 3.
    Amlie-Lefond C, Bernard TJ, Sebire G, Friedman NR, Heyer GL, Lerner NB et al (2009) Predictors of cerebral arteriopathy in children with arterial ischemic stroke: results of the International Pediatric Stroke Study. Circulation 119:1417–1423. CrossRefGoogle Scholar
  4. 4.
    Fusco MR, Harrigan MR (2011) Cerebrovascular dissections-a review part I: spontaneous dissection. Neurosurgery 68(1):242–257. CrossRefGoogle Scholar
  5. 5.
    Debette S (2014) Pathophysiology and relative factors of cervical artery dissection: what have we learnt from large hospital-based cohorts? Curr Opin Neurol 27:20–28. CrossRefGoogle Scholar
  6. 6.
    Debette S, Leys D (2009) Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol 8:668–678. CrossRefGoogle Scholar
  7. 7.
    Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J et al (2006) Vertebral artery dissection: presenting findings and predictors of outcome. Stroke 37:2499–2503. CrossRefGoogle Scholar
  8. 8.
    Arnold M, Bousser M (2005) Carotid and vertebral artery dissection. Pract Neurol 5:100–109. CrossRefGoogle Scholar
  9. 9.
    Thomas LC (2016) Cervical arterial dissection: an overview and implications for manipulative therapy practice. Man Ther 21:2–9. CrossRefGoogle Scholar
  10. 10.
    Nakamizo T, Koide T, Miyazaki H (2015) Progressive intracranial vertebral artery dissection presenting with isolated trigeminal neuralgia-like facial pain. Case Rep Neurol Med 2015:387139. Google Scholar
  11. 11.
    Debette S, Compter A, Labeyrie MA, Uyttenboogaart M, Metso TM, Majersik JJ et al (2015) Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection. Lancet Neurol 14:640–654. CrossRefGoogle Scholar
  12. 12.
    Lee JS, Yong SW, Bang OY, Shin YS, Kim BM, Kim SY (2006) Comparison of spontaneous intracranial vertebral artery dissection with large artery disease. Arch Neurol 63:1738–1744. CrossRefGoogle Scholar
  13. 13.
    Fukuhara K, Ogata T, Ouma S, Tsugawa J, Matsumoto J, Abe H (2015) Impact of initial symptom for accurate diagnosis of vertebral artery dissection. Int J Stroke 10 Suppl A 100:30–33. CrossRefGoogle Scholar
  14. 14.
    Kim JG, Choi JY, Kim SU, Jung JM, Kwon DY, Park MH et al (2015) Headache characteristics of uncomplicated intracranial vertebral artery dissection and validation of ICHD-3 beta diagnostic criteria for headache attributed to intracranial artery dissection. Cephalalgia 35:516–526. CrossRefGoogle Scholar
  15. 15.
    Arnold M, Bousser MG (2005) Clinical manifestations of vertebral artery dissection. Front Neurol Neurosci 20:77–86. CrossRefGoogle Scholar
  16. 16.
    Maruyama H, Nagoya H, Kato Y, Deguchi I, Fukuoka T, Ohe Y et al (2012) Spontaneous cervicocephalic arterial dissection with headache and neck pain as the only symptom. J Headache Pain 13:247–253. CrossRefGoogle Scholar
  17. 17.
    Yamada S, Ohnishi H, Takamura Y, Takahashi K, Hayashi M, Kodama Y et al (2016) Diagnosing intra-cranial and cervical artery dissection using MRI as the initial modality. J Clin Neurosc 33:177–181. CrossRefGoogle Scholar
  18. 18.
    Huma U, Sheikh (2016) Headache in intracranial and cervical artery dissections. Curr Pain Headache Rep 20(2):1–5. Google Scholar
  19. 19.
    Kwon JY, Kim N-Y, Suh DC, Kang D-W, Kwon SU, Kim JS (2015) Intracranial and extracranial arterial dissection presenting with ischemic stroke: lesion location and stroke mechanism. J Neurol Sci Nov 15(1–2):371–376. CrossRefGoogle Scholar
  20. 20.
    Shin JH, Suh DC, Choi CG, Leei HK (2000) Vertebral artery dissection: Spectrum of imaging findings with emphasis on angiography and correlation with clinical presentation. Radiographics 20:1687–1696. CrossRefGoogle Scholar
  21. 21.
    Campos CR, Calderaro M, Scaff M, Conforto AB (2007) Primary headaches and painful spontaneous cervical artery dissection. J Headache Pain 8(3):180–184. CrossRefGoogle Scholar
  22. 22.
    Mokri B (2002) Headaches in cervical artery dissections. Curr Pain Headache Rep 6(3):209–216. CrossRefGoogle Scholar
  23. 23.
    Kerry R, Taylor AJ (2006) Cervical arterial dysfunction assessment and manual therapy. Man Ther 11:243–253. CrossRefGoogle Scholar
  24. 24.
    Taylor A, Kerry R (2010) A ‘system based’ approach to risk assessment of the cervical spine prior to 527 manual therapy. Int J Osteopathic Med 13:85–93. CrossRefGoogle Scholar
  25. 25.
    Thomas LC, Rivett DA, Attia JR, Levi C (2015) Risk factors and clinical presentation of cervical arterial dissection: preliminary results of a prospective case-control study. J Orthop Sports Phys Ther 45:503–511. CrossRefGoogle Scholar
  26. 26.
    Gottesman RF, Sharma P, Robinson KA, Arnan M, Tsui M, Saber-Tehrani A (2012) Clinical characteristics of symptomatic vertebral artery dissection: a systematic review. Neurologist 18:245–254. CrossRefGoogle Scholar
  27. 27.
    Arnold M, Kappeler L, Georgiadis D, Berthet K, Keserue B, Bousser MG et al (2006) Gender differences in spontaneous cervical artery dissection. Neurology 67:1050–1052. CrossRefGoogle Scholar
  28. 28.
    Kim JT, Lee SH, Choi SM, Park MS, Kim BC, Kim MK et al (2008) Spontaneous vertebral artery dissection mimicking cluster headache. Cephalalgia 28:671–673. CrossRefGoogle Scholar
  29. 29.
    Jacob S, Rajabally Y (2007) Short-lasting unilateral neuralgiform headache with cranial autonomic symptoms (SUNA) following vertebral artery dissection. Cephalalgia 27:283–285. CrossRefGoogle Scholar
  30. 30.
    Ro A, Kageyama N, Abe N, Takatsu A, Fukunaga T (2009) Intracranial vertebral artery dissection resulting in fatal subarachnoid hemorrhage: clinical and histopathological investigations from a medicolegal perspective. J Neurosurg 110:948–954. CrossRefGoogle Scholar
  31. 31.
    Ono H, Nakatomi H, Tsutsumi K, Inoue T, Teraoka A, Yoshimoto Y et al (2013) Symptomatic recurrence of intracranial arterial dissections: follow-up study of 143 consecutive cases and pathological investigation. Stroke 44:126–131. CrossRefGoogle Scholar
  32. 32.
    Abou-Chebl A, Krieger DW, Bajzer CT, Yadav JS (2006) Intracranial angioplasty and stenting in the awake patient. J Neuroimaging 16:216–223. CrossRefGoogle Scholar
  33. 33.
    John N, Mitchell P, Dowling R, Yan B (2013) Is general anaesthesia preferable to conscious sedation in the treatment of acute ischaemic stroke with intra-arterial mechanical thrombectomy? Neuroradiology 55:93–100. CrossRefGoogle Scholar
  34. 34.
    Bolay H, Reuter U, Dunn AK, Huang Z, Boas DA, Moskowitz MA (2002) Intrinsic brain activity triggers trigeminal meningeal afferents in a migraine model. Nat Med 8:136–142. CrossRefGoogle Scholar
  35. 35.
    Sheikh HU (2016) Headache in intracranial and cervical artery dissections. Curr Pain Headache Rep 20:8. CrossRefGoogle Scholar
  36. 36.
    Lauritzen M, Dreier JP, Fabricius M, Hartings JA, Graf R, Strong AJ (2011) Clinical relevance of cortical spreading depression in neurological disorders: migraine, malignant stroke, subarachnoid and intracranial hemorrhage, and traumatic brain injury. J Cereb Blood Flow Metab 31:17–35. CrossRefGoogle Scholar
  37. 37.
    Verdelho A, Ferro JM, Melo T, Canhao P, Falcao F (2008) Headache in acute stroke. A prospective study in the first 8 days. Cephalalgia 28:346–354. CrossRefGoogle Scholar
  38. 38.
    Tentschert S, Wimmer R, Greisenegger S, Lang W, Lalouschek W (2005) Headache at stroke onset in 2196 patients with ischemic stroke or transient ischemic attack. Stroke 36:e1-e3. CrossRefGoogle Scholar
  39. 39.
    Mitsias PD, Ramadan NM, Levine SR, Schultz L, Welch KM (2006) Factors determining headache at onset of acute ischemic stroke. Cephalalgia 26:150–157. CrossRefGoogle Scholar
  40. 40.
    Evans RW, Mitsias PD (2009) Headache at onset of acute cerebral ischemia. Headache 49:902–908. CrossRefGoogle Scholar
  41. 41.
    Goddeau RP, Alhazzani A (2013) Headache in stroke: a review. Headache 53:1019–1022. CrossRefGoogle Scholar
  42. 42.
    Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A et al (2017) Cervical artery dissection in patients ≥ 60 years. Neurology 88(14):1313CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
  2. 2.Department of CardiologyHenan Provincial People’s HospitalZhengzhouChina
  3. 3.Department of RehabilitationAffiliated Hospital of Xuzhou Medical UniversityXuzhouChina

Personalised recommendations