6.5.3 Headache attributed to carotid or vertebral angioplasty

Description:
Headache caused by the surgical procedure of cervical angioplasty. 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 or vertebral angioplasty has been performed
C. Evidence of causation demonstrated by all of the following:

    1. headache has developed within 1 week of the angioplasty
    2. headache has resolved within 1 month after the angioplasty
    3. headache is on the same side as the angioplasty

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

Comments:
Percutaneous transluminal angioplasty (PTA) and stenting versus surgery are presently undergoing randomized trials. Data on headache are still scarce, and headache is not mentioned in large series of carotid PTA. In a small series of 53 patients, cervical pain occurred during balloon inflation in one half of patients and head pain in one third, mostly disappearing within seconds of balloon deflation.

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