Characteristics of primary headache caused by cervicocerebral artery dissection

Objective To analyze the characteristics of the primary headache due to cervicocerebral artery dissection (CAD). Methods A total of 146 consecutive patients with CAD in the First Affiliated Hospital of Zhengzhou University from 2010 to 2017 were observed. There were 20 cases who complained of primary headache, of which the characteristics of pain were analyzed according to their clinical features that were collected face to face through questionnaire. According to whether complicated by primary headache, the 146 patients were classified into two groups: 20 cases (13.7%) in the primary headache group, and 126 cases (86.3%) in the non-primary headache group. Results Patients in the primary headache group had a lower prevalence of transient ischemic attack or cerebral infarction compared with the non-primary headache group (30.0% (6/20) vs 77.0% (97/126), χ2=18.338, P<0.01). CAD patients in the primary headache group were more likely involved in posterior circulation compared with the non-primary headache group (85.0% (7/20) vs 55.6% (70/126), χ2=6.214, P=0.013). Of the 20 patients with primary headache, 40.0% (8/20) had continuous headache and 60.0% (12/20) had intermittent headache; 70.0% (14/20) presented with severe headache, 25.0% (5/20) with moderate headache and 5.0% (1/20) with mild headache; For the nature of pain, 60.0% (12/20) was similar to migraine; 11/17 of patients with posterior circulation dissection showed occipital pain. Conclusions The primary headache caused by CAD is a severe pain occurring suddenly, and different from those of previous experiences. The nature of headache is often similar to migraine, which can be continuous or intermittent. In addition, compared with anterior circulation, patients with posterior circulation dissection often have headache as the initial symptom. Key words: Cervicocerebral artery dissection; Headache; Initial symptom; Disease attributes