We describe 4 patients with spontaneous dissecting aneurysm of the intracranial vertebral artery, which presented with headache and neck pain as the only manifestation. The onset of headache and neck pain was gradual in all patients. Pains were distributed to the unilateral posterior head and neck region and were pulsating in 2 patients (50%) and steady in 2 patients (50%) and lasted for several minutes to several hours. The pains sometimes waxed and waned. The pains of the same kind appeared repeatedly. MRA was useful for detecting the vertebral artery abnormalities, such as string sign and aneurysmal dilatation. One patient was treated surgically because of refractory pain. The other patients were treated nonsurgically, i.e. bed rest and pain control. Follow-up MRA demonstrated healing of the dissection.