Pain as the only symptom of cervical artery dissection
Five articles on PainSci cite Arnold 2006: 1. The Complete Guide to Chronic Tension Headaches 2. The Complete Guide to Neck Pain & Cricks 3. What Happened To My Barber? 4. Does Spinal Manipulation Work? 5. When to Worry About Neck Pain … and when not to!
PainSci notes on Arnold 2006:
A study of 245 patients with spontaneous cervical artery dissection found that 20 (8%) of them suffered just one symptom — distinctive pain — even in five who had multiple dissections. It took about a week to diagnose most of them. Only two had neck pain alone, and six had headache alone; twelve had both.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
BACKGROUND: Headache or neck pain is a frequent symptom of spontaneous cervical artery dissection (sCAD).
PATIENTS AND METHODS: Patients were drawn from an ongoing hospital-based registry of consecutive cases diagnosed with sCAD. Only patients with isolated pain were included in this series. Pain topography, dynamics, severity and quality, imaging findings and outcome were analysed.
RESULTS: 20 of 245 (8%) patients with sCAD presented with pain as the only symptom (mean (SD) age 39 (8) years; 14 (70%) women). Of them, 12 had vertebral artery dissection, 3 had internal carotid dissection and 5 had multiple dissections. The median delay from symptom onset to diagnosis was 7 days (range 4 h to 29 days). 6 patients presented with headache, 2 with neck pain and 12 with both. Onset of headache was progressive in 6, acute in 8 and thunderclap-type in 4 patients; neck pain was progressive in 7 and acute in 7. Headache was throbbing in 13 and constrictive in 5 patients; neck pain was throbbing in 4 and constrictive in 10. Pain was unilateral in 11 and bilateral in 9. Pain was different from earlier episodes in all but one case. All patients were pain free at 3 months.
CONCLUSION: Pain may be the only symptom in sCAD, even when multiple arteries are dissected. Pain topography, dynamics, quality and intensity were heterogeneous. Data from this study lend support to recommendations favouring imaging studies of the cervical arteries in patients with new-onset unexplained headache or neck pain.
related content
- “Spontaneous cervicocephalic arterial dissection with headache and neck pain as the only symptom,” Hajime Maruyama, Harumitsu Nagoya, Yuji Kato, Ichiro Deguchi, Takuya Fukuoka, Yasuko Ohe, Yohsuke Horiuchi, Tomohisa Dembo, Akira Uchino, and Norio Tanahashi, J Headache Pain, 2012.
- “Cervical arterial dysfunction: knowledge and reasoning for manual physical therapists,” Roger Kerry and Alan J Taylor, Journal of Orthopaedic & Sports Physical Therapy, 2009.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Photobiomodulation therapy is not better than placebo in patients with chronic nonspecific low back pain: a randomised placebo-controlled trial. Guimarães 2021 Pain.
- No effect of creatine monohydrate supplementation on inflammatory and cartilage degradation biomarkers in individuals with knee osteoarthritis. Cornish 2018 Nutr Res.
- The CANBACK trial: a randomised, controlled clinical trial of oral cannabidiol for people presenting to the emergency department with acute low back pain. Bebee 2021 Med J Aust.
- Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects. Gerhart 2017 Ann Behav Med.
- Modulation in the elastic properties of gastrocnemius muscle heads in individuals with plantar fasciitis and its relationship with pain. Zhou 2020 Sci Rep.