Primary headaches and painful spontaneous cervical artery dissection

Abstract The relation between pri-mary headaches (PH) and pain related to spontaneous cervical artery dissection (SCAD) is still unclear, as well as the progress of PH after dissection. To investigate this relation, the characteristics of pain related to SCAD and changes in PH patterns after SCAD, we evaluated 54 con-secutive patients. Thirty-five (65%) had previous PH. Painful SCAD occurred in 39 (72%). Frontal and parietal localizations were significantly associated with internal carotid artery dissection (p=0.013 and p=0.010, respective-ly), whereas occipital and nuchal pain, with vertebral artery dissec-tion (p=0.047 and p<0.001, respec-tively). Previous PH did not influ-ence the presence of pain at SCAD onset. Twenty-six (74%) patients with PH reported improvement in PH pattern after a mean follow-up of 32 months. These results sug-gest that mechanisms underlying PH do not modulate dissection-related pain. Disruption of perivas-cular afferents may be involved in improvement of PH patterns after SCAD