6.7.4 Headache attributed to intracranial artery dissection


Headache caused by dissection of an intracranial artery. The pain is mostly unilateral, ipsilateral to the dissected vessel, and generally has a sudden (even thunderclap) onset. It can remain isolated or be a warning symptom preceding subarachnoid haemorrhage or stroke.

Diagnostic criteria:
  1. Any new headache fulfilling criterion C
  2. An intracranial arterial dissection has been diagnosed
  3. Evidence of causation demonstrated by at least two of the following:
    1. headache has developed in close temporal relation to other symptoms and/or clinical signs of intracranial arterial dissection, or has led to its diagnosis
    2. headache resolves within 1 month of its onset
    3. headache has either or both of the following characteristics:
      • a) sudden or thunderclap onset
      • b) severe intensity
      • headache is unilateral and ipsilateral to the dissection
  4. Not better accounted for by another ICHD-3 diagnosis.

Dissection can affect any intracranial artery and may induce subarachnoid haemorrhage, ischaemic infarcts, compression of adjacent structures or, less commonly, intracerebral haemorrhage. In Asians, intracranial arterial dissection is more frequent than cervical artery dissection.

Acute headache is often the presenting symptom and can be the sole symptom of this disorder.