Pain Characteristics and Diagnosing Intracranial Vertebral Artery Dissection

A study, published in Cephalalgia, supports delineation of the pain characteristics in the diagnosis between headache and ischemic type intracranial vertebral artery dissection (IC-VAD).

The researchers performed a retrospective study inquiry for unruptured IC-VAD diagnoses over a 6½-year period. A 15-question survey was distributed to the identified participants (N=63) that had unilateral lesions. There was a 61% (n=39) response rate, and this data was used to compare headache type and ischemic type IC-VAD. Two respondents were excluded from the survey studies due to not experiencing headaches; of the remaining participants, 24 had headache type and 13 had ischemic type IC-VAD.

Survey results on the general characteristics of headache resultant from unruptured IC-VAD showed that 89% respondents experienced headaches in the occipitonuchal region, 81% had unilateral headaches, 70% had an acute onset headache, and 83% said their present headache was different from other headaches. As for how respondents described the pain, 73% called it severe, 70% called it pulsatile, 11% said it was dull, 8% said constrictive, 5% said burning, and 5% said electrical. A total of 65% said it was the worst pain they’d ever experienced.

As for triggers, 41% said body motion was a major aggravating factor, while 68% experienced headaches while awake and 18% had them while asleep. At 81% of respondents, nearly everyone had concomitant clinical symptoms when the headache occurred, but 73% reported no nausea or vomiting. For 97%, their headaches resolved in 1 month.

Comparative studies on headache characteristics between headache type and ischemic type IC-VAD respondents showed headache type IC-VAD respondents experienced greater severity and worst headache ever (P =.01) in comparison to ischemic type IC-VAD respondents. Ischemic type IC-VAD respondents experienced concomitant clinical symptoms (P =.03) more frequently; they also experienced nausea and vomiting more frequently (but the results were not statistically significant).

Researchers showed their study criteria was consistent with diagnostic criteria shown in ICHD-3 beta and the Clinical Practice Guideline for Chronic Headache 2013. The most consistent criterion was duration (97%) pain intensity, and location followed at 70%. The authors devised a scoring system based on their results for headache characteristics. To conclude, the investigators believe the headache characteristics discussed in their study can be helpful in the diagnosis of IC-VAD.

Reference

Matsumoto H, Hanayama H, Sakurai Y, et al. Investigation of the characteristics of headache due to unruptured intracranial vertebral artery dissection [published online August 6, 2018]. Cephalalgia. doi: 10.1177/0333102418791818