The carotid artery is the arterial vessel that distributes blood away from the heart towards the head and brain. The carotid artery is called the carotid artery in Latin. It carries oxygen-rich blood that has been enriched with oxygen from the lungs in the cardiopulmonary circulation.
The carotid artery originates on the left side directly from the aorta (the aortic arch), on the right side it branches off from an intermediate piece, the brachiocephalic trunk. On both sides it is initially present as a common carotid artery, but then divides into an inner and an outer branch, 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 gland, pharynx and larynx) with blood.
Between the branches are receptors called the carotid sinus and the carotid glomus. The carotid sinus is a pressure gauge that measures blood pressure and can transmit information to the brain. The glomus caroticum is a chemoreceptor that can measure the oxygen content of the blood and transmit this information to the brain. If the carotid artery hurts, the causes can be muscular tension or a narrowing of the blood vessels (stenosis). After an accident or a blow to the neck, carotid dissection can occur.
Symptoms
Patients usually describe pressure pain above the carotid artery. It may also be hardened and palpable when arteriosclerotic changes (calcifications) are present. In cases of muscle tension, the pain tends to run along a muscle, for example along the sternocleidomastoid muscle.
Differential diagnoses for sore throats also include lymph node swelling, difficulty swallowing and thyroid inflammation or disease. Likewise, an infection of the throat can lead to pain in the neck, which is often accompanied by difficulty swallowing and general symptoms such as fever and fatigue. Bilateral pain in the area of the carotid artery can occur as a symptom of a bacterial or viral infection.
If, on the other hand, the pain is restricted to the right side, it may be angina lateralis (lateral strangulation). It affects the lymphatic vessels that run along the back wall of the throat. In most cases, it is pathogens that settle there after a viral infection and cause further, general symptoms of the disease.
Right-sided tonsillitis, which is usually caused by bacteria, also causes a one-sided clinical picture with general disease symptoms. If there are no signs of infection, a dissection, a tear of the vessel wall, the right carotid artery, should be considered. If painful complaints occur in the carotid artery after applying pressure, it is not the vessel itself that must be directly affected, but rather structures above it.
These include muscles such as the sternocleidomastoid muscle, which can be affected by tension, or swollen lymph nodes as part of an infectious event. Irritation of the nerves supplying the jaw and neck muscles is also not excluded. Pain in the area of the carotid artery, which radiates from the jaw, can on the one hand indicate muscle tension, for example of the masticatory muscles, or be associated with carotid dissection, a splitting of the vessel wall layers with subsequent bleeding.
Teeth grinding during sleep, which often occurs as a result of stress, can be considered one of the causes of muscular tension. The pain is not limited to the jaw region, but also extends to the carotid artery. Angina lateralis (lateral strangulation) with infectious colonization of the lymphatic channels of the posterior pharyngeal wall causes not only unilateral pain in the lateral neck region, but also general disease symptoms.
Fever, aching limbs, difficulty swallowing, but also pain radiating into the ear are possible. In the further course of the disease, affected persons may suffer from ear pain. But there is not always an infectious cause.
Tension-related pain, often in connection with stress, in the area of the carotid artery can also cause ear pain. Muscle tension in the region surrounding the ear acts as a trigger. Pain in the carotid artery during inhalation may indicate muscle tension in the neck muscles or an infectious event and in most cases is not indicative of pain in the artery itself.
In particular, the so-called cervical flipper muscle, the sternocleidomastoid muscle, can be affected by painful tension. Furthermore, a blockage of the cervical vertebral bodies should also be considered.For headaches associated with carotid artery pain, nerve involvement should be considered. These are usually symptoms that persist over a long period of time and are due to muscular tension or blockages in the vertebral region.
Sudden, stabbing headaches should be taken seriously. They can be related to a narrowed carotid artery or dissection of the carotid artery and require urgent clarification. If the carotid artery hurts, it is often due to muscular tension.
Due to poor posture when sitting (computer work, etc.) or 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 artery is a narrowing of this artery, which is called carotid stenosis. This occurs in the course of arteriosclerosis, i.e. a calcification of the vessels. Arteriosclerosis often develops in old age, but can occur more quickly and earlier due to some risk factors.
These include a high cholesterol level (hypercholesterolemia), which often occurs in combination with overweight. Cholesterol accumulates in unhealthy nutrition and little physical activity. Alcohol and nicotine also lead to high cholesterol levels.
High blood pressure is also one of the risk factors for carotid stenosis. As a result of the narrowing of the blood vessels, pain in the neck area can occur, whereby the stenosis itself is usually asymptomatic, i.e. the patient does not notice it at all. Due to the stenosis, the risk of stroke is greatly increased, since clots may preferentially form at this point.
Warning signals are speech and vision disorders, paralysis and sensitivity disorders such as deafness. Carotid stenosis is therefore not a harmless disease. After a blow to the neck, or a traffic accident, carotid dissection can also occur.
A dissection is a separation of the vascular membranes so that a second membrane is formed inside the artery. This can be accompanied by pain in the neck area, with the pain often radiating into the shoulder. Pain at the back of the head is also frequently described.
When “settling” by the chiropractor or physiotherapist, such a dissection can also occur. However, a dissection can also occur without any recurrent trauma, especially in the case of congenital connective tissue weaknesses such as Ehlers-Danlos syndrome. Since a dissection can also lead to the formation of a clot that displaces the carotid artery, there is a risk of a stroke.
In carotid sinus syndrome, the glomus caroticus, the pressure gauge on the carotid bifurcation, is hypersensitive to pressure, so that when pressure is applied, the heart rate or pulse (bradycardia) slows down and blood pressure drops (hypotension). This can lead to cardiac arrest. This can be caused by the pressure of a tumor in the neck area, pressure due to arteriosclerotic changes or even a tie that presses on the glomus caroticus.
In rare cases, a head tilt backwards can also trigger 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 younger people between the ages of 40 and 50.
An arterial vascular dissection is the separation of two layers of the wall. In most cases, it is a splitting of the innermost and middle layer with subsequent bleeding and unilateral pain. In most cases, carotid dissection occurs spontaneously and seems to be related to a genetic predisposition.
Accidents or medical interventions can also be the cause. In about 1% of cases, blood clots form at the site of the tear and lead to a blockage of the vessels supplying the brain. Depending on the area of the brain affected, patients show neurological abnormalities and should be treated immediately 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. Brief neurological deficits, such as impaired vision or temporary paralysis, should be considered as warning signs of a stroke.