title: [Neck pain and headache as the only manifestation of cervical artery dissection].
abstract: OBJECTIVE
  To analyze clinical and neuroimaging data in patients with neck pain and headache as the only manifestation of the internal carotid artery (ICA) dissection (ICAD) and vertebral artery (VA) dissection (VAD).
  
  
  METHODS
  One hundred and sixty-one patients (mean age - 37.4±4,99 years, 84 women, 52%) with cervical artery dissection (CAD) verified by magnetic resonance imaging (MRI) were enrolled. Neck pain and headache were the only CAD manifestation in 33 patients (mean age 37,3±7,4 yars, 28 women, 85%).
  
  
  RESULTS
  The localization of the dissections in these patients was the following: one VA (15 patients), two VA (9), one ICA (7), two ICA (1), one ICA + two VA (1). The whole number of dissected arteries was 45: extracranial localization - 38, extra-intracranial - 6, intracranial - 1. Dissection led to stenosis of the arterial lumen in 41 arteries, to occlusion - in 2 and to dual lumen in 2 arteries. Small aneurism was found in 4 arteries. Combination of headache and the neck pain was observed in 26 out of 33 patients (79%), the only headache in 4 patients, the only neck pain in 3 patients. Along with this, 9 out of 24 VAD patients had the shoulder and/or arm pain. Headache in VAD patients was located more often in the occipital region (18 out of 24) that had never been observed in ICAD patients (p=0.0009). Fronto-temporal pain was observed more often in ICAD patients (5 out of 8 patients) than in VAD (2 out of 24 patients) (p=0.003). Neck pain in all VAD patients in comparison with 3 out ofI8 [CAD patients had posterior localization (p=0,007). Anterolateral neck pain was observed in 4 out ofI8 ICAD patients and in no patients with VAD (p=0.0009). The pain appearance was abrupt in all ICAD patients and most of the VAD patients. In 8 VAD patients the pain has been increasing during several hours. The pain intensity was severe in 19 patients, moderate in 12 and mild in 2. The characteristics of the pain were as following: constrictive/dull (26 patients), throbbing (1 patient) or combined (6 patients). Pain was increasing in a stepwise manner during the first days in 14 out of 24 VAD patients and in no one of ICAD patients (p=0.008). The mean pain duration period was 31 8 ± 15,7 days. Pain relief drugs were ineffective or had a short effect in 97% of patient.
  
  
  CONCLUSIONS
  Isolated pain is more characteristic for women with VAD. Usually pain is presented as a combination of headache and neck pain. Pain localization, mode of appearance and the course are different in VAD and ICAD. The rarity of occlusion among patients with <<pain-only>> manifestation let to suggest that the intramural hematoma in this group of patients spreads to the adventitia that can reflect media weakness. Arterial wall changes underlying its weakness seem to be sex-hormone dependent taking into consideration the high predominace of women in cad manifested by isolated pain.
authors.affiliation: Research Center of Neurology Russian Academy of Sciences, Moscow.
authors.forename: L A
authors.initials: LA
authors.lastname: Kalashnikova
authors.affiliation: Research Center of Neurology Russian Academy of Sciences, Moscow.
authors.forename: L A
authors.initials: LA
authors.lastname: Dobrinina
authors.affiliation: Research Center of Neurology Russian Academy of Sciences, Moscow.
authors.forename: M V
authors.initials: MV
authors.lastname: Dreval
authors.affiliation: Research Center of Neurology Russian Academy of Sciences, Moscow.
authors.forename: E V
authors.initials: EV
authors.lastname: Doronina
authors.affiliation: Research Center of Neurology Russian Academy of Sciences, Moscow.
authors.forename: M A
authors.initials: MA
authors.lastname: Nazarova
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006261:Headache / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019547:Neck Pain / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D017211:Treatment Failure
chemical_list: D000700:Analgesics