Carotid dissection presenting as a prolonged cluster-like headache in a patient with episodic cluster headache

[CHfather]

"Carotid artery dissection" is not dissecting the carotid artery; it's a medical condition in which layers of the wall of the carotid artery are torn or otherwise separated.  I find this interested in part because it might possibly explain some rare situations we see here, and because there is a doctor at UCLA who has found that repairing a certain type of hole in the heart cures migraines in people who have that hole.  So there might be some cardiovascular connection emerging.  Or not.

http://www.docguide.com/carotid-dissection-presenting-prolonged-cluster-headache-patient-episodic-cluster-headache?tsid=5

We present a patient with known episodic cluster headache, who presented with cluster-like headache in the course of internal carotid artery dissection (ICAD) and discuss possible pathophysiological links between the two diseases. It is well known that cluster-like headache could be the presenting symptom of ICAD. However, ICAD occurring in a patient with a known episodic cluster headache was only once previously described. In the end of the manuscript, we propose red flags to help clinicians differentiate between primary cluster headache and cluster-like attacks masking underlying ICAD. Finally, we raise the question whether at least some proportion of those patients with cluster headache and Horner syndrome previously classified as a primary headache disorder might have been secondary cases to ICAD.