title: Headache characteristics of uncomplicated intracranial vertebral artery dissection and validation of ICHD-3 beta diagnostic criteria for headache attributed to intracranial artery dissection.
abstract: OBJECTIVE
  Headache may be a warning sign of subsequent stroke in patients with vertebral artery dissection (VAD). Even though the headache characteristics of VAD have been described predominantly in patients with extracranial VAD and neurological complications, headache semiology is not well known in patients with uncomplicated intracranial vertebral artery dissection (ICVAD). In the present study, we attempt to identify the headache semiology that characterizes ICVAD and validate the revised version of the International Classification of Headache Disorders (ICHD-3 beta) criteria for headache attributed to intracranial artery dissection.
  
  
  METHODS
  Six patients with neurologically uncomplicated ICVAD presented at a participating medical center, and eight similar patients were reviewed in the literature. Combining these data, we analyzed headache characteristics of patients with uncomplicated ICVAD according to their pain onset and duration, nature, intensity, location, aggravating and relieving factors, associated symptoms, response to medication, and prognosis.
  
  
  RESULTS
  Headache in uncomplicated ICVAD usually has an acute mode of onset (11/14) and persistent (10/14) temporal feature. Pain that has a throbbing quality (nine of 14) and severe intensity (13/14) on the ipsilesional (10/14) and occipitonuchal area (12/14) is a headache prototype in ICVAD. Additionally, headache was intensified by head flexion and rotation (three of six), and relieved by head extension and supine positioning (five of six). Headache of all patients in the present study fulfilled the ICHD-3 beta criteria.
  
  
  CONCLUSIONS
  Headache semiology of uncomplicated ICVAD is mostly homogenous in the present study. These characteristics may be helpful in the diagnosis of uncomplicated ICVAD.
authors.affiliation: Department of Neurology, Korea University College of Medicine, Korea University Anam Hospital, Republic of Korea.
authors.forename: Jae-Gyum
authors.initials: JG
authors.lastname: Kim
authors.affiliation: Department of Neurology, Korea University College of Medicine, Korea University Ansan Hospital, Republic of Korea a-yeong@hanmail.net.
authors.forename: Jeong-Yoon
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Department of Neurology, Korea University College of Medicine, Korea University Ansan Hospital, Republic of Korea.
authors.forename: Sung Un
authors.initials: SU
authors.lastname: Kim
authors.affiliation: Department of Neurology, Korea University College of Medicine, Korea University Ansan Hospital, Republic of Korea.
authors.forename: Jin-Man
authors.initials: JM
authors.lastname: Jung
authors.affiliation: Department of Neurology, Korea University College of Medicine, Korea University Ansan Hospital, Republic of Korea.
authors.forename: Do-Young
authors.initials: DY
authors.lastname: Kwon
authors.affiliation: Department of Neurology, Korea University College of Medicine, Korea University Ansan Hospital, Republic of Korea.
authors.forename: Moon Ho
authors.initials: MH
authors.lastname: Park
authors.affiliation: Department of Neurology, Korea University College of Medicine, Korea University Guro Hospital, Republic of Korea.
authors.forename: Kyungmi
authors.initials: K
authors.lastname: Oh
mesh_terms: D000328:Adult; D002533:Cerebral Angiography; D005260:Female; D006261:Headache / Q000209:etiology*; D006801:Humans; D038801:International Classification of Diseases; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020217:Vertebral Artery Dissection / Q000150:complications* / Q000175:diagnosis*
keywords: Intracranial vertebral artery dissection; headache; headache attributed to intracranial artery dissection; secondary headache