What are the other Names for this Condition? (Also known as/Synonyms)

• Post-Carotid Endarterectomy Headache

What is Post-Endarterectomy Headache? (Definition/Background Information)

• Post-Endarterectomy Headache is a headache disorder that occurs secondary to carotid endarterectomy surgery. The headache may be accompanied by neck and/or facial pain, and is mostly a post-operative complication that resolves early when managed adequately
• Carotid artery endarterectomy is a surgical procedure that involves removal of the plaque that causes obstruction and subsequent hardening and narrowing of the carotid artery. The carotid artery is a major artery that provides blood to the head and neck
• It is reported that the post-procedure headache may be a potential indicator of a ‘future’ brain stroke. However, in nearly 90% of the cases, the headache may be self-limiting, or spontaneously resolve within about 14 days of surgery
• In as many as 10% of the individuals who have undergone the carotid artery endarterectomy procedure, there may be other neurological signs and symptoms with increased blood pressure and seizures, a condition termed hyperperfusion syndrome, which merits urgent investigation and treatment
• Differential diagnosis: It is important to exclude arterial dissection in the head and neck region via suitable tests and procedures prior to arriving at a diagnosis of Post-Endarterectomy Headache

The criteria for diagnosis of Post-Endarterectomy Headache as outlined by the International Headache Society (IHS) is given below:

• Carotid endarterectomy has been performed
• Any new headache fulfilling the criterion below

Evidence of causation demonstrated by at least two of the following:

• Headache develops within 1 week of the carotid endarterectomy
• Headache resolves within 1 month after the carotid endarterectomy
• Both of the following:
  • Headache is unilateral, on the side of the carotid endarterectomy
  • Headache has one of the following three distinct characteristics - diffuse mild pain; or a cluster headache-like pain occurring once or twice a day in attacks lasting 2-3 hours; or, pulsating severe pain

Not better accounted for by another ICHD-3 diagnosis.

Based on the type of headache that appears, Post-Endarterectomy Headache is categorized into the following subtypes:

• A diffuse, mild isolated headache occurring in the first few days after surgery
• A unilateral cluster headache-like pain with attacks, lasting 2-3 hours, occurring once or twice a day
• Unilateral pulsating and severe pain occurring 3 days after surgery

(Source: International Headache Society Classification ICHD-3, London, United Kingdom)