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Published on 31.10.2017
Table 1: Clinical characteristics of head and neck pain in 34 patients with ICAD or VAD. | |||||||
CAD (n = 39) | ICAD (n = 28) | VAD (n = 11) | |||||
No. | % | No. | % | No. | % | ||
Head and or neck pain | 34 | 87 | 26 | 93 | 8 | 73 | |
Head pain only | 12 | 35 | 10 | 38 | 2 | 25 | |
Neck pain only | 4 | 12 | 1 | 4 | 3 | 38 | |
Head and neck pain | 18 | 53 | 15 | 58 | 3 | 38 | |
Onset | Seconds | 7 | 21 | 3 | 12 | 4 | 50 |
Minutes | 16 | 47 | 12 | 46 | 4 | 50 | |
Hours | 11 | 32 | 11 | 42 | 0 | 0 | |
Duration | 1–60 minutes | 1 | 3 | 0 | 0 | 1 | 13 |
1–24 hours | 4 | 12 | 1 | 4 | 3 | 38 | |
1–7 days | 14 | 41 | 13 | 50 | 1 | 13 | |
1–4 weeks | 14 | 41 | 12 | 46 | 2 | 25 | |
Persistent | 1 | 3 | 0 | 0 | 1 | 13 | |
Dynamics | Continuous | 12 | 35 | 8 | 31 | 4 | 50 |
Undulating | 11 | 32 | 10 | 38 | 1 | 13 | |
Recurrent | 11 | 32 | 8 | 31 | 3 | 38 | |
Frequency | With accompagnying symptoms | 34 | 100 | 26 | 100 | 8 | 100 |
First symptom | 23 | 68 | 17 | 65 | 6 | 75 | |
Unknown | 2 | 6 | 2 | 8 | 0 | 0 | |
Quality* | 47 | 39 | 12 | ||||
Pressing | 17 | 36 | 14 | 36 | 3 | 25 | |
Stabbing | 13 | 28 | 10 | 26 | 3 | 25 | |
Pulsating | 7 | 15 | 5 | 13 | 2 | 17 | |
Burning | 1 | 2 | 4 | 10 | 1 | 8 | |
Pulling | 5 | 11 | 2 | 5 | 3 | 25 | |
Explosive | 1 | 2 | 1 | 3 | 0 | 0 | |
Electifiying | 1 | 2 | 1 | 3 | 0 | 0 | |
Toothache like | 1 | 2 | 1 | 3 | 0 | 0 | |
Unknown | 1 | 2 | 1 | 3 | 0 | 0 | |
Localisation head pain* | 56 | 51 | 5 | ||||
Frontal | 8 | 14 | 8 | 16 | 0 | 0 | |
Periorbital | 6 | 11 | 5 | 10 | 1 | 20 | |
Maxillary region | 3 | 5 | 3 | 6 | 0 | 0 | |
Mandibular region | 2 | 4 | 2 | 4 | 0 | 0 | |
Auricular | 6 | 11 | 6 | 12 | 0 | 0 | |
Temporal | 7 | 13 | 6 | 12 | 1 | 20 | |
Parietal | 6 | 11 | 6 | 12 | 0 | 0 | |
Occipital | 18 | 32 | 15 | 29 | 3 | 60 | |
Localisation neck pain* | 28 | 21 | 6 | ||||
Posterior neck region | 17 | 61 | 10 | 48 | 6 | 100 | |
Lateral neck region | 7 | 25 | 7 | 33 | 0 | 0 | |
anterior neck region | 4 | 14 | 4 | 19 | 0 | 0 | |
Laterality of head pain | 30 | 25 | 5 | ||||
Unilateral | 20 | 67 | 17 | 68 | 3 | 60 | |
Ipsilateral | 19 | 95 | 16** | 64 | 3 | 60 | |
Unknown | 1 | 5 | 0 | 0 | 0 | 0 | |
Bilateral | 10 | 33 | 8 | 32 | 2 | 40 | |
Laterality of neck pain | 22 | 16 | 6 | ||||
Unilateral | 16 | 73 | 11 | 69 | 5 | 83 | |
Ipsilateral | 16 | 100 | 11 | 100 | 5 | 100 | |
Bilateral | 6 | 27 | 5 | 31 | 0 | 0 | |
Pain scale | Mean VAS | 6 | 6 | 5 | |||
Maximal VAS | 7 | 7 | 7 | ||||
CAD = cervical artery dissection, ICAD = internal carotid artery dissection, VAD = vertebral artery dissection, VAS = visual analogue scale. * For quality and localisation multiple specifications were possible and taken in account. ** 1 out of 17 presented with change from ipsi- to contralateral. |
Table 2: Medical history of 39 patients with CAD. | |||
CAD (n = 39) | |||
No. | % | ||
History of headache | 28 | 72% | |
Family history of headache | 21 | 54% | |
Unknown history of headache | 3 | 8% | |
History of migraine | 18 | 46% | |
Migraine with aura | 4 | 10% | |
Migraine without aura | 14 | 36% | |
Family history of migraine | 14 | 36% | |
Unknown history of migraine | 1 | 3% | |
History of neurological disease | 0 | 0% | |
History of anxiety | 2 | 5% | |
History of depression | 3 | 8% | |
History of diabetes mellitus | 0 | 0% | |
History of sinusitis | 17 | 44% | |
Smoker | 23 | 59% | |
Active | 11 | 48% | |
Previous | 11 | 48% | |
Unknown | 1 | 4% | |
Precursor event | 38 | 97% | |
Previous Infection | 8 | 21% | |
Previous trauma | 7 | 18% | |
Oral contraceptive use* | 3 | 20% | |
CAD = cervical artery dissection * Only women (n = 15) taken into account |
Table 3: Trigeminal autonomic symptoms in 36 patients with CAD. | ||
CAD (n = 36)* | ||
No. | % | |
Trigeminal autonomic symptoms | 27 | 69% |
Lacrimation | 7 | 26% |
Red eye | 6 | 22% |
Miosis | 17 | 63% |
Ptosis | 18 | 67% |
Itchy eye | 6 | 22% |
Foreign body in eye | 4 | 15% |
Eyelid oedema | 2 | 7% |
Rhinorrhoea | 3 | 11% |
Occluded nose | 6 | 22% |
Facial flush | 2 | 7% |
Facial hidrosis | 5 | 19% |
Ear pressure | 2 | 7% |
Postnasal drip | 2 | 7% |
CAD = cervical artery dissection * Due to lack of recall, data of only 36 patients was obtained |
Table 4: Comparison of accompanying symptoms in patients with ICAD and VAD. | |||||
ICAD (n = 28) | VAD (n = 11) | ||||
No. | % | No. | % | ||
Trigeminal autonomic symptoms | 21 | 75% | 6 | 55% | |
Miosis | 15 | 71% | 2 | 33% | |
Ptosis | 15 | 71% | 3 | 50% | |
Migraine-like symptoms | 22 | 79% | 10 | 91% | |
Other accompagnying symptoms | 19 | 68% | 10 | 91% | |
ICAD = internal carotid artery dissection, VAD=vertebral artery dissection. For specific symptoms see table 3a–c. |
Table 5: Migraine-like symptoms in 39 patients with CAD. | |||
CAD (n = 39) | |||
No. | % | ||
Migraine like symptoms | 32 | 82% | |
Nausea | 19 | 59% | |
Emesis | 8 | 25% | |
Photophobia | 13 | 41% | |
Phonophobia | 12 | 38% | |
Osmophobia | 5 | 16% | |
Physical activity-induced aggravation | 14 | 44% | |
Aura-like symptoms | 12 | 38% | |
Visual | 11 | 92% | |
Somatosensory | 1 | 8% | |
Motor | 1 | 8% | |
Aphasia | 1 | 8% | |
Agitation | 8 | 25% | |
Allodynia | 6 | 19% | |
CAD = cervical artery dissection |
Table 6: Other accompanying symptoms in 39 patients with CAD. | ||
CAD (n = 39) | ||
No. | % | |
Other accompanying symptoms | 29 | 74% |
Vertigo | 4 | 14% |
Dizziness | 16 | 55% |
Tinnitus | 7 | 24% |
Tiredness | 23 | 79% |
Disturbed concentration | 12 | 41% |
Yawning | 4 | 14% |
Change in urinary frequency | 2 | 7% |
Neck stiffness | 14 | 48% |
Depression | 4 | 14% |
CAD = cervical artery dissection |
Table 7: Migraine triggers in 34 patients with CAD and head or neck pain. | |||
CAD (n = 34) | |||
No. | % | ||
Triggers | 15 | 38% | |
No memory | 1 | 3% | |
Not asked | 5 | 13% | |
Alcohol | 2 | 13% | |
Noise | 3 | 20% | |
Sharp light | 3 | 20% | |
Chocolat | 0 | 0% | |
Caffein withdrawal | 1 | 7% | |
Nitroglycerin Intake | 0 | 0% | |
Olfactory stimulus | 1 | 7% | |
Tactile stimulus | 1 | 7% | |
Sleep deprevation | 10 | 67% | |
Oversleeping | 1 | 7% | |
Altitude | 2 | 13% | |
Weather condition | 3 | 20% | |
Menstruation* | 2 | 13% | |
No memory | 1 | 7% | |
CAD = cervical artery dissection. * Only women (n = 15) taken into account |
Table 8: Psychosocial stress in 39 patients with CAD. Overall and with pain. | |||||
CAD (n = 39) | CAD and pain as a symptom (n = 34) | ||||
No. | % | No. | % | ||
Any Stress | 35 | 90% | 30 | 88% | |
Stress at work | 32 | 82% | 28 | 82% | |
Sometimes | 7 | 22% | 5 | 18% | |
Often | 5 | 16% | 4 | 14% | |
Permanently | 20 | 63% | 19 | 68% | |
Stress at home | 17 | 44% | 15 | 44% | |
Sometimes | 5 | 29% | 4 | 27% | |
Often | 3 | 18% | 3 | 20% | |
Permanently | 9 | 53% | 8 | 53% | |
Financial stress | 3 | 8% | 2 | 6% | |
Moderately | 0 | 0% | 0 | 0% | |
High | 3 | 100% | 2 | 100% | |
CAD = cervical artery dissection. Using an adapted questionnaire utilized by the interheart study for psychosocial stress measurements in patients with myocardial infarction. Evaluation of psychosocial stress as a risk factor for CAD and factor of aggravation of pain in patients with CAD. |
Table 9: Physical activity in 39 patients with CAD. | ||
CAD (n = 39) | ||
No. | % | |
Physical activity | ||
Intensive physical activity at work Average of 3.8 hours per day on 4.5 days per week. | 6 | 15% |
Intensive physical activity at home Average of 1.4 hours per day on 3.1 days per week. | 17 | 44% |
Moderate physical activity at work Average of 3 hours per day on 3.4 days per week. | 9 | 23% |
Moderate physical activity at home Average of 1.6 hours per day on 3.1 days per week. | 27 | 69% |
CAD = cervical artery dissection. Using the GPAQ (Global physical activity questionnaire) issued by the World Health Organization. Evaluation of physical activity as a protection factor for CAD. |
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