6.5.1.2 Persistent headache or facial or neck pain attributed to past cervical carotid or vertebral artery dissection

Identification: Male patient, 45 years old, with a history of spontaneous dissection of the right vertebral artery 3 months ago, treated with anticoagulation.

Chief Complaint: Persistent right unilateral cervical pain, pulsatile in nature and of moderate to severe intensity, with continuous duration since the initial event. The pain radiates to the right occipital region and worsens with neck movements.

History of Present Illness: Following mild cervical trauma (sudden rotation during physical activity), the patient developed sudden and intense cervical pain, associated with vertigo and nausea. Angiography confirmed dissection of the right vertebral artery. Despite the resolution of ischemic symptoms (no stroke), the cervical pain persists.

Physical/Neurological Examination: No focal deficits. Mild tenderness to palpation in the right suboccipital region. Absence of meningeal signs or pupillary changes.

Complementary Exams: Follow-up MR angiography shows healing of the dissection, with persistence of mild residual stenosis.