title: Pain as the only symptom of cervical artery dissection.
abstract: BACKGROUND
  Headache or neck pain is a frequent symptom of spontaneous cervical artery dissection (sCAD).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Assistance Publique, Hôpitaux de Paris, Department of Neurology, University Hospital Lariboisière, Paris, France. marcel.arnold@insel.ch
authors.forename: M
authors.initials: M
authors.lastname: Arnold
authors.forename: R
authors.initials: R
authors.lastname: Cumurciuc
authors.forename: C
authors.initials: C
authors.lastname: Stapf
authors.forename: P
authors.initials: P
authors.lastname: Favrole
authors.forename: K
authors.initials: K
authors.lastname: Berthet
authors.forename: M-G
authors.initials: MG
authors.lastname: Bousser
mesh_terms: D000328:Adult; D020215:Carotid Artery, Internal, Dissection / Q000150:complications* / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006261:Headache / Q000209:etiology*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology*; D010147:Pain Measurement; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D020217:Vertebral Artery Dissection / Q000150:complications* / Q000175:diagnosis*