6.5.3 Headache attributed to carotid or vertebral angioplasty or stenting

Description:

Headache caused by the endovascular procedures of cervical angioplasty and/or stenting. Pain can also involve the neck and face. It can remain isolated or be a warning symptom preceding the focal deficits of (mostly haemorrhagic) stroke.

Diagnostic criteria:
  1. Any new headache, fulfilling criterion C
  2. Carotid or vertebral angioplasty and/or stenting has been performed
  3. Evidence of causation demonstrated by all of the following:
    1. headache has developed within 1 week of the angioplasty and/or stenting
    2. headache has resolved within 1 month after the angioplasty and/or stenting
    3. headache is on the same side as the angioplasty and/or stenting
  4. Not better accounted for by another ICHD-3 diagnosis1.
Note:

In particular, arterial dissection has been excluded by appropriate investigations.

Comments:

Carotid and vertebral angioplasty and/or stenting are performed to treat cervical artery stenosis.

In a series of 64 patients who had carotid stenting, headache occurred in one third, usually within 10 minutes after the procedure, and was mild, ipsilateral, frontotemporal and pressing in nature; it mostly disappeared within 10 minutes. Otherwise data on 6.5.3 Headache attributed to carotid or vertebral angioplasty or stenting remain scarce. Headache is not mentioned in large trials comparing carotid stenting and endarterectomy.

6.5.3 Headache attributed to carotid or vertebral angioplasty or stenting has been reported as part of the rare hyperperfusion syndrome.