Persistent headache attributed to past cervicocephalic artery dissection: clinical characterization and predictors of headache persistence

Abstract

Background: Persistent headache or facial/neck pain attributed to past cervicocephalic arterial dissection (CCAD) has been under-documented in the literature; however, it can significantly contribute to decreasing quality of life. Our main goal was to evaluate clinical characteristics and predictors of headache persistence after CCAD (HPCCAD). Methods: A retrospective cohort study was performed, including patients with CCAD, between 2005-2020 in a Portugal tertiary hospital. HPCCAD was defined using the International Classification of Headache Disorders third edition. Demographics and clinical data were obtained via clinical records and HPCCAD characterization through a telephonic questionnaire. Results: Ninety patients were identified with CCAD; 22 (24%) had HPCCAD. Between HPCCAD and no-HPCCAD patients, there were no differences concerning gender, age, and vascular risk factors. HPCCAD group had more frequently headache history (64% vs. 5%, p<0.001), delay from symptoms-diagnosis (3.6 days vs. 1.9, p<0.001), and headache/cervical pain as the first acute symptom (81.2% vs. 43%, p<0.001). A logistic regression model depicted previous headache history, posterior CCAD, and lower initial NIHSS as predictive factors of HPCCAD. Conclusion: Few studies characterized HPCCAD and even less addressed its predictors. In our study, about a quarter of patients with a history of dissection had HPCCAD. Previous headache history, posterior circulation dissection, and less severe disease were identified as predictors of headache persistence.