Abstract WP548: Incidence and Prevalence of Headache in Cranio-Cervical Artery Dissection Patients

Abstract

Introduction: Spontaneous craniocervical artery dissection (CeAD) occurs commonly in healthy individuals without known risk factors for stroke, whereas traumatic CeAD varies widely from penetrating trauma to motor vehicle crashes to minor movements of the neck. Headache (HA) and cervical pain occur in up to 75% of patients with CeAD. Yet, there are limited data on the incidence of new HA in CeAD patients after diagnosis. Methods: All patients from January 2015 to May 2017 consecutively identified by an electronic medical record-based application were enrolled in this prospective longitudinal registry. CeAD was confirmed by imaging during acute hospital visits. Patients were consented and followed for 12 months for HA status and HA Impact Test-6 (HIT-6) score (little to no impact: 49 or less, some impact: 50-55, substantial impact: 56-59, severe impact 60+). Results: The cohort included 111 CeAD patients (age 53 ± 15.9 years, 56% Caucasian, 50% female). Prevalence of reported HA at baseline was 40% (n=44) of enrolled patients; yet, there was no reportable difference between HA and no HA based on dissection location (carotid n=62; vertebral n=41; or basilar n=2; p=0.445). At baseline, 43% of patients categorized their HA as severely impacting their lives based on HIT-6. At the 3-month follow up, there was an incidence of 16% (n=11) who now reported HA but had no HA at baseline. At 3 months, 57% of patients categorized their HA as severely impacting on their life. At the 12-month follow up, there was an incidence of 7% (n=4) who now reported HA but no previous HA at baseline or 3 months. At 12 months, 58% of patients were classified into the severe impact category determined using HIT-6 calculations. HA status was not found to be associated with stroke or traumatic brain injury from CeAD (p = non-significant). Conclusions: We report the incidence and prevalence of HA within the CeAD population over a 12-month period. A high prevalence level was observed (40%) within the baseline history of CeAD diagnosis, with incremental incidence of new HA (16% and 7%) reported at 3 months and 12 months, respectively. There was no association found between HA status and stroke, dissection location or traumatic brain injury.