Migraine-like presentation of vertebral artery dissection after cervical manipulative therapy

Summary Headache is the common symptom in patients with cervical artery dissection. However, it rarely occurs in isolation, without focal neurological signs, and even more rarely mimics migraine. We present a clinical case of young woman with new severe throbbing unilateral headache which started one week after cervical manipulative therapy. No history of migraine was present. Vertebral artery dissection was diagnosed after duplex ultrasound and CT angiography. Local symptoms and signs were absent, and diffusion-weighted MRI did not show any acute brain ischemic lesions. Throbbing headache gradually resolved in 10 days. Follow-up 5 months later showed near-complete normalization of lumen and flow of dissected vertebral artery. The possibility of extracranial dissection should be considered in patients with first attack of migraine-like hemicrania, especially if cervical manipulations or trauma occurred recently.