6.5.2 Post-endarterectomy headache

Description:
Headache caused by the surgical procedure of carotid endarterectomy. 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:
A. Any new headache fulfilling criterion C
B. Carotid endarterectomy has been performed
C. Evidence of causation demonstrated by at least two of the following:

    1. headache develops within 1 week of carotid endarterectomy
    2. headache resolves within 1 month after carotid endarterectomy
    3. headache is unilateral, on the side of the carotid endarterectomy, and has one of the following three characteristics:

      a) diffuse mild pain
      b) cluster headache-like pain occurring once or twice a day in attacks lasting 2-3 hours
      c) pulsating severe pain

D. Not better accounted for by another ICHD-3 diagnosis, and arterial dissection has been excluded by appropriate investigations.

Comment:
Three subforms of 6.5.2 Post-endarterectomy headache have been described (but are not separately coded). The most frequent (up to 60% of cases) is a diffuse, mild isolated headache occurring in the first few days after surgery. It is a benign self-limiting condition. The second subform (reported in up to 38% of cases) is a unilateral cluster headache-like pain with attacks, lasting 2-3 hours, occurring once or twice a day. It resolves in about two weeks. The third subform is part of the rare hyperperfusion syndrome, with a unilateral pulsating and severe pain occurring three days after surgery. It often precedes a rise in blood pressure and the onset of seizures or neurological deficits on or about the seventh day. Urgent treatment is required, since these symptoms can herald cerebral haemorrhage.