The carotid artery is the arterial vessel that distributes the blood away from the heart toward the head and brain. The carotid artery is called in Latin Arteria carotis . It carries oxygen-rich blood that has been oxygenated in the cardiopulmonary circulation of the lungs. The carotid artery originates directly on the left side of the main artery (the aortic arch), on the right it descends from an intermediate part, the brachiocephalic trunk . On both sides it is initially present as a common common carotid artery, but then divides into an inner and an outer branch, into the internal carotid artery and the external carotid artery .
The inner branch supplies the brain and the eye with blood, the outer part supplies the head including the neck organs (thyroid, throat and larynx) with blood. In each case, there are receptors between the branching, called the carotid sinus and the carotid body. The carotid sinus is a pressure gauge that measures blood pressure and can pass information to the brain. The carotid body is a chemoreceptor that, among other things, can measure the oxygen content of the blood and transmit it to the brain.
When the carotid hurts, causes can be muscular tension or stenosis . Carotid dissection may occur following an accident or a blow to the neck.
The patients usually describe tenderness over the carotid artery. It may also be palpable when arteriosclerotic changes (calcifications) are present. In muscle tension, the pain tends to run along a muscle, for example, along the sternocleidomastoid muscle .
In the case of sore throats, lymph node swelling, dysphagia and thyroid inflammation or diseases may also be considered as differential diagnoses. Likewise, an infection of the throat and throat area can lead to pain in the neck, which are often accompanied by dysphagia and general symptoms such as fever and fatigue.
Bilateral pain in the area of the carotid artery can be a symptom of a bacterial or viral infection.
If, on the other hand, it is a condition limited to the right side, it may be an angina lateralis (lateral transeptina). It affects the lymphatics that run along the posterior pharyngeal wall. Most of them are pathogens that settle there after a viral infection and cause other, general disease symptoms.
A right tonsillitis, which is usually triggered by bacteria, also causes a one-sided symptoms with general disease symptoms.
In case of missing signs of an infection, a dissection, a tearing of the vessel wall, the right carotid artery should be considered.
If painful discomfort on the carotid artery occurs after applying pressure, then the vessel need not be directly affected, but rather structures above it. These include on the one hand muscles such as the sternocleidomastoid muscle, which may be affected by tension, or swollen lymph nodes as part of an infectious event. Even irritation of the nerves supplying the jaw and neck muscles is not excluded.
Pain in the area of the carotid artery, which radiate from the jaw, on the one hand on a muscle tension, for example, the masticatory muscles indicate, or in connection with a carotid dissection, a splitting of the vessel wall layers with subsequent hemorrhage, stand. Teeth grinding during sleep, which often occurs due to stress, may be considered one of the causes of muscular tension. The pain is not limited to the jaw region, but also pull towards the carotid artery.
An angina lateralis (infra-lateral gangrene ) with infectious colonization of the lymphatics of the posterior pharyngeal wall causes side-neck pain in addition to one-sided pain, as well as general illnesses. Fever, body aches, dysphagia, but also radiating pain in the ear are possible. In the further course affected persons can suffer from earache. But there is not always an infectious cause.
Tension-related pain, often associated with stress, in the area of the carotid artery can also cause earache. Muscle tension in the ear surrounding region acts as a trigger.
Pain in the carotid artery during inhalation may indicate muscular tension in the cervical muscles or an infectious event, and in the vast majority of cases is not indicative of discomfort to the artery itself. In particular, the so-called Halswender muscle, the sternocleidomastoid muscle may be affected by a painful tension. Furthermore, it should also be thought of a blockage of the cervical vertebrae.
Nervous involvement should be considered for headache associated with carotid artery disease. Most of these are prolonged-duration symptoms due to muscular tension or blockages in the spinal area.
Sudden, stinging headaches should urgently be taken seriously. They may be related to a narrowed carotid artery or dissection of the carotid and require urgent clarification.
When the carotid hurts, it is often due to muscular tension. Bad posture when sitting (computer work, etc.) or by little movement, the neck muscles are often affected by tension. This can project into the neck and be misinterpreted as pain from the carotid artery.
The most common disease of the carotid is a narrowing of this artery, called carotid stenosis . This arises in the context of arteriosclerosis, ie calcification of the vessels. Arteriosclerosis often occurs in old age, but can be caused by some risk factors faster and earlier. This includes a high cholesterol level ( hypercholesterolemia ), which often occurs combined with obesity. Cholesterol increases in unhealthy diet and little physical activity increasingly. Alcohol and nicotine also lead to high cholesterol levels. Likewise, high blood pressure is one of the risk factors for carotid stenosis. As a result of vasoconstriction can cause pain in the neck area, the stenosis itself is usually asymptomatic, which means that it is not noticed by the patient. Stenosis greatly increases the risk of stroke, as clots may preferentially develop at this site. Warning signs include speech and visual disturbances, paralysis and sensory disorders such as deafness. Therefore, carotid stenosis is not a safe disease.
After a blow on the neck, or a traffic accident, a carotid dissection can occur. A dissection is a separation of the vascular hides, creating a second membrane inside the artery. This can be associated with pain in the neck area, with the pain often radiating to the shoulder. Pain is often described on the back of the head. When "choking" by the chiropractor or physiotherapist may also come to such a dissection. However, a dissection can occur even without a trauma, especially in congenital connective tissue weaknesses such as the Ehlers-Danlos syndrome. Since a dissection can also form a clot that displaces the carotid artery, there is a risk of stroke.
In the carotid sinus syndrome, the carotid artery, the pressure gauge on the carotid fork, is hypersensitive to pressure, causing a slowing of the heart rate or heart rate ( bradycardia ) and a fall in blood pressure ( hypotension ) when pressure is applied. This can lead to a cardiac arrest. The reason for this may be the pressure of a tumor in the neck area, pressure due to arteriosclerotic changes or even a tie that presses on the carotid body . Rarely can a head tilt backwards cause the syndrome. However, the area around the carotid artery rarely hurts.
A dissection of the carotid artery, is one of the most common triggers for a stroke in the younger age between the 40th and 50th year of life.
Arterial vessel dissection is the separation of two wall layers. Mostly it is a splitting of the innermost and middle layer with subsequent hemorrhage and unilateral pain.
In most cases, carotid dissection occurs spontaneously and appears to be associated with genetic predisposition. Even accidents or medical interventions can be the cause.
In about 1% of cases, blood clots form at the tear site and lead to obstruction of the brain-supplying vessels. Affected persons show neurological abnormalities depending on the affected brain area and should be treated promptly in the stroke unit of a hospital.
Deposits on the vessel walls of the carotid artery in the sense of a so-called carotid stenosis can also be the cause. Short neurological deficits, such as visual disturbances or temporary paralysis, are to be considered as signs of stroke.
Pain in the carotid artery
In case of muscle tension, physiotherapy exercises, back and posture schools as well as sports activities help to relieve the pain. In addition, good posture and ergonomic workplaces should be considered. In an acute pain event, for example after a sudden movement ("neck dislocation"), heat helps to release the spasm.
The carotid stenoses are almost always due to arteriosclerosis, ie calcification of the vessels. The more the vessel is narrowed, the more likely a stroke or harbinger of stroke, a transient ischemic attack (TIA), can develop. In transient ischemic attack all symptoms of stroke are possible (blurred vision, speech disorders, balance disorders, paralysis), but these disappear completely within one day. The carotid stenosis must often be surgically treated in the case of a strong degree of stenosis of the carotid artery. Here are two different operation options available. During the stent operation, a stent, ie a vascular support, is inserted into the narrowed segment, which in the future will keep the vessel open at this point. In thrombendarteriectomy, ie the removal of thrombus, the atherosclerosis or a clot is removed at this point. This operation is slightly larger, as the artery has to be cut longitudinally. It is disputed which method is better. A large study indicated the equivalence of both methods.
For carotid dissections, a therapeutic dilution therapy and control often suffice.
Depending on the severity of the carotid sinus syndrome, occasionally a pacemaker must be installed to prevent fainting ( syncope ).
To diagnose, the doctor can palpate (carotid) the carotid artery and listen with the stethoscope. When the artery becomes narrowed due to atherosclerosis or clots, you can often hear a stethoscope sound. Ultrasound diagnostics are a good way to detect a narrowing. In addition, the flow direction of the blood can be displayed. With magnetic resonance imaging (MRI) or magnetic resonance angiography, the arteries can be accurately visualized and evaluated.
The prognosis for carotid stenosis is good, as they are often asymptomatic. For higher-grade stenoses, surgical therapy should be considered to reduce the risk of stroke. Especially after a transient ischemic attack, which is a harbinger of stroke, a medical examination should be made. The prognosis for carotid dissections is usually very favorable. By an anticoagulant therapy, the dissection often returns without a thrombus and thus a stroke develops.
To prevent carotid stenosis, it is recommended that the cholesterol content be kept within normal limits. This can be done with a healthy balanced, possibly low cholesterol diet and sufficient exercise. In addition, the sugar content and blood pressure should be kept at a healthy level, as all these parameters can contribute to the development of arteriosclerosis. In addition, to reduce the risk of arteriosclerosis no or little nicotine and alcohol should be consumed.