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Andadola U, Poornima S, Galappatthy G. Cardiac cephalalgia-headache as an atypical presentation of ST-segment elevation myocardial infarction: a case report. BMC Cardiovasc Disord 2025; 25:435. [PMID: 40483483 PMCID: PMC12145586 DOI: 10.1186/s12872-025-04898-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 05/29/2025] [Indexed: 06/11/2025] Open
Abstract
BACKGROUND Ischaemic heart disease commonly presents with chest pain and autonomic symptoms; however, atypical manifestations can occur. Cardiac cephalalgia is a rare presentation of acute coronary syndrome, characterised by a migraine-like headache triggered by myocardial ischaemia. Diagnosis requires a high index of suspicion. CASE PRESENTATION We describe a 47-year-old man with diabetes and a history of smoking who presented with an acute, severe frontotemporal headache accompanied by nausea and vomiting. Electrocardiography revealed ST-segment elevation in the inferior leads. Coronary angiography demonstrated multivessel coronary artery disease involving the right coronary artery and the left anterior descending artery. A subsequent measurement of serum troponin I confirmed myocardial injury. Both arteries were successfully stented, leading to clinical improvement and resolution of the headache. CONCLUSIONS This case highlights the importance of considering cardiac causes in patients presenting with severe headaches particularly in those with cardiovascular risk factors.
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Affiliation(s)
- Udayanga Andadola
- Department of Primary Care and Family Medicine, Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Ratnapura, Sri Lanka.
| | - Subhani Poornima
- Cardiology Unit, The National Hospital of Sri Lanka, Colombo, Sri Lanka
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2
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Antoun I, Helal A, Wassef N, Farooq M. Ischaemic Heart Disease Masquerading as Headache: A Case Series. Catheter Cardiovasc Interv 2025. [PMID: 40152017 DOI: 10.1002/ccd.31521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Revised: 03/20/2025] [Accepted: 03/23/2025] [Indexed: 03/29/2025]
Abstract
Headache is a rare yet clinically significant presentation of ischaemic heart disease (IHD). While chest pain is the hallmark symptom of myocardial ischaemia (MI), some patients present with atypical symptoms, such as headaches, which lead to diagnostic challenges and potential delays in treatment. This case series highlights the diagnostic complexity and clinical significance of headache-predominant presentations of both acute and chronic coronary syndromes, emphasizing the need for a comprehensive differential diagnosis in patients with cardiovascular risk factors. We present two cases where headache was the primary symptom of MI. The first case describes an acute ischaemic event wherein the headache preceded the onset of classic cardiac symptoms, leading to the identification of an occluded obtuse marginal artery. This was the second case in our institution where a previous patient presented with exertion-induced headaches, ultimately diagnosed as a chronic total occlusion of the left anterior descending (LAD) artery, which was successfully revascularised. Two years later, the same patient re-presented with acute coronary syndrome secondary to disease in a different coronary artery and his presentation was solely with headache. Both cases were successfully managed with percutaneous revascularisation, resulting in the resolution of symptoms and reinforcing the link between headache and CAD. These cases underscore the importance of considering ACS and chronic stable angina in patients presenting with unexplained headaches, particularly when symptoms are exertional or pressure-like. Early cardiac assessment, including ECG and further imaging when indicated, is essential for timely intervention. Raising the awareness of exertional headache as a potential ischaemic symptom may facilitate earlier diagnosis and prevent adverse outcomes. Further research is required to elucidate the mechanisms underlying headaches in MI and refine diagnostic approaches for atypical cardiac presentations.
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Affiliation(s)
- Ibrahim Antoun
- Department of Cardiology, Kettering General Hospital, Kettering, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ayman Helal
- Department of Cardiology, Kettering General Hospital, Kettering, UK
| | - Nancy Wassef
- Department of Cardiology, Gloucestershire Hospital Foundation Trust, Gloucestershire, UK
| | - Mohsin Farooq
- Department of Cardiology, Kettering General Hospital, Kettering, UK
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Cui H, Zhang L, Zhu T, Liu R, Yuan X. Headache as the sole clinical manifestation of acute myocardial infarction: one case with cardiac cephalalgia and literature review. Coron Artery Dis 2024; 35:607-613. [PMID: 38870021 DOI: 10.1097/mca.0000000000001394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Cardiac cephalalgia, once seen as a rare symptom of coronary artery disease, is now more recognized. It often comes with chest discomfort and autonomic dysfunction, worsened by physical activity. However, not all cases have chest symptoms or are activity induced. This report presents a case of cardiac cephalalgia and reviews 46 previous cases. METHOD We discuss a unique case where a patient had headache attacks without chest symptoms, autonomic dysfunction, or triggers. We reviewed English case reports of cardiac cephalalgia from 1982 to 2022 using PubMed ( http://www.ncbi.nlm.nih.gov/pubmed ). RESULTS A 69-year-old man presented with a sudden headache without triggers or typical symptoms. Coronary computed tomography angiography (CTA) showed diffuse stenosis in the left anterior descending and the first diagonal branch arteries. His headache improved after percutaneous coronary intervention. Cardiac cephalalgia is usually marked by severe headaches, autonomic signs, and often affects the occipital region. Electrocardiogram (ECG) might not always show abnormalities, and chest pain is not always present. In such cases, elevated cardiac enzymes can be crucial for diagnosis. CONCLUSION When a headache is the sole symptom of an acute coronary event, consider moderate to severe intensity, older age at onset, occipital localization, and autonomic signs. ECG, cardiac enzymes, and coronary CTA are valuable for accurate diagnosis and treatment.
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Affiliation(s)
- Huili Cui
- Department of Neurology, Zhengzhou People's Hospital Affiliated Henan University of Traditional Chinese Medicine, Zhengzhou, China
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4
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Montenegro M, Cutrer FM. Cough, Exertional, and Sex Headaches. Neurol Clin 2024; 42:599-614. [PMID: 38575269 DOI: 10.1016/j.ncl.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
In this article, the authors review the most common presentations of cough and exertional headaches and headaches associated with sexual activity. The authors elaborate on the most commonly described etiologies and identify those which are most critical to treat. The authors outline the recommendations for further evaluation and discuss effective treatment modalities for each headache type.
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Affiliation(s)
- Monique Montenegro
- General Neurology and Headache Division, University of Minnesota Medical School, Minneapolis, MN, USA
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Lagman-Bartolome AM, Im J, Gladstone J. Headaches Attributed to Disorders of Homeostasis. Neurol Clin 2024; 42:521-542. [PMID: 38575264 DOI: 10.1016/j.ncl.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Headaches attributed to disorders of homeostasis include those different headache types associated with metabolic and systemic diseases. These are headache disorders occurring in temporal relation to a disorder of homeostasis including hypoxia, high altitude, airplane travel, diving, sleep apnea, dialysis, autonomic dysreflexia, hypothyroidism, fasting, cardiac cephalalgia, hypertension and other hypertensive disorders like pheochromocytoma, hypertensive crisis, and encephalopathy, as well as preeclampsia or eclampsia. The proposed mechanism behind the causation of these headache subtypes including diagnostic criteria, evaluation, treatment, and overall management will be discussed.
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Affiliation(s)
- Ana Marissa Lagman-Bartolome
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto; Department of Pediatrics, Division of Neurology, Children's Hospital, London Health Sciences Center, Schulich School of Medicine & Dentistry, University of Western Ontario, 800 Commissioner's Road East, London, Ontario N6A5W9, Canada.
| | - James Im
- Department of Medicine, Division of Adult Neurology, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B1W8, Canada
| | - Jonathan Gladstone
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto; Gladstone Headache Clinic, 1333 Sheppard Avenue E, Suite 122, North York, Ontario M2J1V1, Canada
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6
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Navarro-Pérez MP, Espinosa-Rueda J, Ballesta-Martínez S, Revilla-Martí P, Olesen J, Bellosta-Diago E, Santos-Lasaosa S. Prevalence, clinical characteristics and associated factors of cardiac cephalalgia: A prospective study. Cephalalgia 2023; 43:3331024231160743. [PMID: 36918763 DOI: 10.1177/03331024231160743] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND The prevalence of cardiac cephalalgia is unknown and there is limited information about its clinical features. We aimed to assess the prevalence of cardiac cephalalgia, its clinical characteristics and associated factors. METHODS We conducted a prospective study of patients with suspected acute coronary syndrome admitted to the Cardiology Service at Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain, over a one-year period. We interviewed patients within the first 24 hours of admission using a standardized case-report form to assess the presence of headache in relation to the acute coronary syndrome and its characteristics. RESULTS We included 438 patients, 381 with confirmed myocardial ischemia. Prevalence of cardiac cephalalgia was 14.2% (n = 54). The most common features were frontal location, pressing quality and moderate intensity. Pain referred to the jaws (aOR 2.61; 95% CI 1.33-5.12; p = 0.005), palpitations (aOR 3.65; 95% CI 1.57-8.50; p = 0.003) and circumflex coronary artery as the culprit artery for the myocardial ischemia (aOR 3.8; 95% CI 1.07-13.74; p = 0.021) were related to cardiac whereas history of hypertension was inversely associated (aOR 0.37: 95% CI 0.18-0.74; p = 0.005). CONCLUSION The prevalence of cardiac cephalalgia was 14.2%. Our study provides valuable information about cardiac cephalalgia characteristics that suggest revision of current diagnostic criteria.
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Affiliation(s)
- María Pilar Navarro-Pérez
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Aragon Institute for Health Research, Zaragoza, Spain
| | - Judit Espinosa-Rueda
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Aragon Institute for Health Research, Zaragoza, Spain
| | - Sara Ballesta-Martínez
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Aragon Institute for Health Research, Zaragoza, Spain
| | - Pablo Revilla-Martí
- Aragon Institute for Health Research, Zaragoza, Spain.,Cardiology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Jes Olesen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Elena Bellosta-Diago
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Aragon Institute for Health Research, Zaragoza, Spain
| | - Sonia Santos-Lasaosa
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Aragon Institute for Health Research, Zaragoza, Spain
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Navarro-Pérez MP, Bellosta-Diago E, Olesen J, Santos-Lasaosa S. Cardiac cephalalgia: a narrative review and ICHD-3 criteria evaluation. J Headache Pain 2022; 23:136. [PMID: 36266636 PMCID: PMC9583508 DOI: 10.1186/s10194-022-01508-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac cephalalgia is an unusual condition that occurs during an episode of myocardial ischemia. Information about cardiac cephalalgia is scarce and its characteristics and physiopathology remain unclear. Our aim is to provide a narrative review of clinical characteristics and physiopathology of cardiac cephalalgia and to evaluate the current diagnostic criteria. METHODS: A search through PubMed was undertaken for studies on cardiac cephalalgia published until 20th September 2022. We summarized the literature and provide a comprehensive review of the headache characteristics and possible mechanisms. We also evaluated current International Classification of Headache Disorders third edition diagnostic criteria based on prior reported cases. RESULTS: In total, 88 cases were found. Headache characteristics were variable. Occipital location and throbbing pain were the most frequently reported. Headache was accompanied in most cases by cardiac symptoms. Criterion B was fulfilled by 98% of cases, criterion C1 by 72%, and criteria C2a and C2b by 37 and 93.2%, respectively. Regarding headache features described in diagnostic criterion C3, 'moderate to severe intensity', 'accompanied by nausea', 'not accompanied by photophobia or phonophobia' and 'aggravated by exertion', were reported in 75, 31, 55 and 55% of cases, respectively. CONCLUSION Cardiac cephalalgia characteristics are variable and the headache features described in the diagnostic criterion C3 might not be adequate. Given that cardiac cephalalgia can be the manifestation of a life-threatening condition it is important to increase the knowledge about this entity.
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Affiliation(s)
- María Pilar Navarro-Pérez
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, San Juan Bosco 15, 50009, Saragossa, Spain.
- Aragon Institute for Health Research (IIS Aragón), Saragossa, Spain.
| | - Elena Bellosta-Diago
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, San Juan Bosco 15, 50009, Saragossa, Spain
- Aragon Institute for Health Research (IIS Aragón), Saragossa, Spain
| | - Jes Olesen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Sonia Santos-Lasaosa
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, San Juan Bosco 15, 50009, Saragossa, Spain
- Aragon Institute for Health Research (IIS Aragón), Saragossa, Spain
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Kobata H. Cardiac cephalalgia: a case series of four patients and updated literature review. Int J Emerg Med 2022; 15:33. [PMID: 35906565 PMCID: PMC9336087 DOI: 10.1186/s12245-022-00436-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cardiac damage is common in patients with acute brain injury; however, little is known regarding cardiac-induced neurological symptoms. In the International Classification of Headache, Third Edition (ICHD-III), cardiac cephalalgia is classified as a headache caused by impaired homeostasis. Methods This report presents four patients with acute myocardial infarction (AMI) who presented with headache that fulfilled the ICHD-III diagnostic criteria for cardiac cephalalgia. A systematic review of cardiac cephalalgia using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines is also presented. Results Case 1: A 69-year-old man with a history of percutaneous coronary intervention (PCI) developed sudden severe occipital pain, nausea, and cold sweating. Coronary angiography (CAG) revealed occlusion of the right coronary artery (RCA). Case 2: A 66-year-old woman complained of increasing occipitalgia and chest discomfort while riding a bicycle. CAG demonstrated 99% stenosis of the left anterior descending artery. Case 3: A 54-year-old man presented with faintness, cold sweating, and occipitalgia after eating lunch. CAG detected occlusion of the RCA. Case 4: A 72-year-old man went into shock after complaining of a sudden severe headache and nausea. Vasopressors were initiated and emergency CAG was performed, which detected three-vessel disease. In all four, electrocardiography (ECG) showed ST segment elevation or depression and echocardiography revealed a left ventricular wall motion abnormality. All patients underwent PCI, which resulted in headache resolution after successful coronary reperfusion. A total of 59 cases of cardiac cephalalgia were reviewed, including the four reported here. Although the typical manifestation of cardiac cephalalgia is migraine-like pain on exertion, it may present with thunderclap headache without a trigger or chest symptoms, mimicking subarachnoid hemorrhage. ECG may not always show an abnormality. Headaches resolve after successful coronary reperfusion. Conclusions Cardiac cephalalgia resulting from AMI can present with or without chest discomfort and even mimic the classic thunderclap headache associated with SAH. It should be recognized as a neurological emergency and treated without delay. Supplementary Information The online version contains supplementary material available at 10.1186/s12245-022-00436-2.
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Affiliation(s)
- Hitoshi Kobata
- Osaka Mishima Emergency Critical Care Center, 11-1 Minamiakutagawa-cho Takatsuki, Osaka, 569-1124, Japan.
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Nanda C, Mehta Y. Isolated Headache as a Symptom of the Acute Coronary Syndrome in a Case following Myocardial Revascularization. JOURNAL OF CARDIAC CRITICAL CARE TSS 2022. [DOI: 10.1055/s-0042-1749323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractRetrosternal chest pain is the classical symptom of acute coronary syndrome (ACS). ACS sometimes presents with atypical symptoms and very rarely as headache as the only symptom. We present here a case where a patient who had undergone coronary artery bypass grafting presented with headache and on evaluation found to have complete occlusion of right coronary artery.
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Affiliation(s)
- Chinmaya Nanda
- Medanta Institute of Critical Care and Anaesthesiology, Gurgaon, Haryana, India
| | - Yatin Mehta
- Medanta Institute of Critical Care and Anaesthesiology, Gurgaon, Haryana, India
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10
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Abstract
OBJECTIVE To investigate the clinical characteristics of cardiac cephalalgia and determine whether there is a more suitable alternative criterion. METHOD Patients with cardiac cephalalgia diagnosed and treated from May 2019 to April 2021 in the First Affiliated Hospital of Zhengzhou University (Zhengzhou, China) were prospectively and consecutively collected, their clinical manifestations were analyzed, and compared with the 2018 diagnostic criteria. RESULTS A total of 30 patients were collected, including 16 males and 14 females. The onset age ranged from 31 to 84 years old, with a mean of 64.6 ± 11.9 years. Headache was more common in unilateral or bilateral frontotemporal, and the nature of pain includes pulsating, dull, stuffy pain, throbbing and so on. 80.0% were moderate to severe, 70% lasted less than half an hour, 76.6% had chest pain, 70% had chest tightness, 63.3% had sweating, and 36.6% had nausea. After treatment with drugs or coronary angiogenesis, except for one death, headache was fully or partially relieved in 29 patients. CONCLUSION Cardiac cephalalgia is generally located in frontotemporal region, of moderate or severe intensity, with a pulsating or throbbing sensation, abating within 30 minutes, and has a good prognosis. Accompanying chest pain, chest tightness, and sweating should be included in the diagnostic criteria.
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Affiliation(s)
- Jia Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ningning Mao
- Department of Rehabilitation Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Chengze Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jilun Feng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Non-invasive vagus nerve stimulation modulates trigeminal but not somatosensory perception: functional evidence for a trigemino-vagal system in humans. Pain 2022; 163:1978-1986. [PMID: 35082253 DOI: 10.1097/j.pain.0000000000002595] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Non-invasive vagus nerve stimulation (nVNS) is effective in several types of headache disorders. We sought to unravel the mechanism of how nVNS exhibits this efficacy. This study used a randomized, single-blind, sham-controlled, crossover-design, and comprised three projects with three independent cohorts of healthy participants. Project I (n=15) was explorative. Six quantitative sensory test (QST) parameters, including mechanical pain threshold (MPT), were measured over the left V1 dermatome and forearm, and compared before and after unilateral nVNS. Projects II (n=20) and III (n=21) were online pre-registered . QST parameters were compared over the left (Project II) or bilateral V1 and V3 dermatomes (Project III), respectively, in addition to the left forearm as a control. A secondary analysis of heart rate variability (HRV) using a historical control group was used to control for systemic effects of nVNS. Verum-nVNS induced trigeminal-specific modulation of pain threshold (i.e., MPT) over the left V1 in Project I, left V1 and V3 in Project II, and bilateral V1 and V3 in Project III. Data pooled from Project II and III demonstrated greater increase of MPT in the V1 vs. V3 dermatome. There were no differences associated with sham-nVNS in any projects. HRV parameters did not change after nVNS. Our results provide functional evidence of a long hypothesized functional trigemino-vagal system in humans and may explain why nVNS is effective in some headache but not in somatic pain disorders. Since unilateral nVNS modulated the trigeminal thresholds bilaterally, this effect is probably indirect through a central top-down mechanism.
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Sun L, Zhang Q, Li N, Bao S, Wang D, Li X. Cardiac cephalalgia closely associated with acute myocardial infarction. Am J Emerg Med 2021; 47:350.e1-350.e3. [PMID: 33744054 DOI: 10.1016/j.ajem.2021.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 12/25/2022] Open
Abstract
Cardiac cephalalgia is an uncommon symptom occurring in coronary artery disease. It is difficult to identify cardiac cephalalgia and link it to coronary artery disease because these patients present with only a headache and no typical symptoms of angina, such as chest pain, radiating pain, or chest tightness. Currently, the diagnostic value of cardiac cephalalgia in acute myocardial infarction is still under debate. We here report a case of cardiac cephalalgia. An 83-year-old woman with a severe headache lasting 6 h was diagnosed with acute myocardial infarction. ST elevation and severe stenosis of the right coronary artery were observed. Passage of the guide wire and radiocontrast agent increased the intensity of the headache, which disappeared once the right coronary artery was opened. As of one month into follow-up, the headache had not recurred. These observations strongly indicate a close association between cardiac cephalalgia and acute myocardial infarction, and they could help diagnose acute myocardial infarction related to headaches.
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Affiliation(s)
- Li Sun
- Department of Emergency Medicine, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250014, China
| | - Qingshan Zhang
- Department of Emergency Medicine, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250014, China
| | - Nannan Li
- Department of Emergency Medicine, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250014, China
| | - Shuai Bao
- Department of Emergency Medicine, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250014, China
| | - Deqi Wang
- Department of Cardiology, ZaoZhuang Municipal Hospital, Zaozhuang 277100, Shandong 250031, China
| | - Xiaolu Li
- Department of Emergency Medicine, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250014, China.
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Ruiz Ortiz M, Bermejo Guerrero L, Martínez Porqueras R, González de la Aleja J. Cardiac cephalalgia: when myocardial ischaemia reaches the neurologist's consultation. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Cardiac cephalgia: When myocardial ischaemia reaches the neurologist's consultation. Neurologia 2020; 35:614-615. [PMID: 31780317 DOI: 10.1016/j.nrl.2019.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/31/2019] [Accepted: 09/07/2019] [Indexed: 12/22/2022] Open
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15
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Bi YC, Gong L. Headache and sick sinus syndrome: A case report. World J Clin Cases 2020; 8:2629-2633. [PMID: 32607342 PMCID: PMC7322413 DOI: 10.12998/wjcc.v8.i12.2629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/12/2020] [Accepted: 06/02/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sick sinus syndrome is a common disease in cardiology. Typical symptoms include palpitations, dizziness, shortness of breath, chest tightness, and amaurosis. However, to date, there are no known reports of sick sinus syndrome presenting with headache. Whether there is a correlation between headache and sick sinus syndrome merits further research. In this report, we describe a case of headache induced by sick sinus syndrome.
CASE SUMMARY A 73-year-old female patient presented to our department with the chief complaint of recurrent paroxysmal headache for more than 7 years. The patient described paroxysmal palpations, usually headache occurring after palpitation. Her blood pressure was normal when the most recent headache occurred. A magnetic resonance imaging study and magnetic resonance angiography of the head at another center were normal. A clinical neurological examination was negative. A 24-h Holter electrocardiogram monitoring study showed sick sinus syndrome. The patient received dual chamber pacing implantation and was administered drug therapy to control ventricular rate. The patient’s paroxysmal headaches and palpitations had resolved within 1 year, confirmed via a follow-up telephone call.
CONCLUSION After dual-chamber pacing implantation and drug therapy administration to control the ventricular rate, the patient’s paroxysmal headaches and palpitations had resolved within 1 year, confirmed via a follow-up telephone call. We believe that the headaches were related to the patient’s sick sinus syndrome.
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Affiliation(s)
- You-Cai Bi
- Department of Neurology, Zigong Fourth People’s Hospital, Zigong 643000, Sichuan Province, China
| | - Liang Gong
- Department of Neurology, Chengdu Second People’s Hospital, Chengdu 650017, Sichuan Province, China
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Lazari J, Money-Kyrle A, Wakerley BR. Cardiac cephalalgia: severe, non-exertional headache presenting as unstable angina. Pract Neurol 2018; 19:173-175. [DOI: 10.1136/practneurol-2018-002045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2018] [Indexed: 11/04/2022]
Abstract
Cardiac cephalalgia is a migraine-like headache that occurs during episodes of myocardial ischaemia. Clinical characteristics of the headache vary widely but are often severe in intensity, worsen with reduced myocardial perfusion and resolve with reperfusion. It can present along with typical symptoms of angina pectoris, although not always. We present a 64-year-old man with a 6-month history of severe, non-exertional headaches occurring with increasing frequency. A resting ECG showed ST elevation in the inferior leads. His serum troponin I was not elevated. Coronary angiography showed severe stenosis of his right coronary artery, which was successfully stented by percutaneous coronary intervention. He remains headache free at 2-year follow-up.
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Starling AJ. Diagnosis and Management of Headache in Older Adults. Mayo Clin Proc 2018; 93:252-262. [PMID: 29406202 DOI: 10.1016/j.mayocp.2017.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/07/2017] [Accepted: 12/06/2017] [Indexed: 01/03/2023]
Abstract
Headache is a common, disabling neurologic problem in all age groups, including older adults. In older adults, headache is most likely a primary disorder, such as tension-type headache or migraine; however, there is a higher risk of secondary causes, such as giant cell arteritis or intracranial lesions, than in younger adults. Thus, based on the headache history, clinical examination, and presence of headache red flags, a focused diagnostic evaluation is recommended, ranging from blood tests to neuroimaging, depending on the headache characteristics. Regardless of the primary or secondary headache disorder diagnosis, treatment options may be limited in older patients and may need to be tailored to the presence of comorbid medical conditions. The purpose of this review is to provide an update on the management of headache in older adults, from diagnosis to treatment.
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18
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Shankar A, Allan CLM, Smyth D, Jardine D. Cardiac cephalgia: a diagnostic headache. Intern Med J 2016; 46:1219-1221. [PMID: 27734618 DOI: 10.1111/imj.13217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/10/2016] [Accepted: 04/14/2016] [Indexed: 11/27/2022]
Abstract
A 73-year-old man presented with a 6-month history of exertional headaches. Exercise tolerance test demonstrated progressive ischaemic changes concomitant with worsening headache. Cardiac cephalgia was diagnosed and his symptoms resolved after coronary artery bypass surgery. Cardiac cephalgia may occasionally present as exertional headache without chest symptoms.
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Affiliation(s)
- A Shankar
- Department of General Medicine, Christchurch Hospital, Christchurch, New Zealand
| | - C L M Allan
- Department of General Medicine, Christchurch Hospital, Christchurch, New Zealand.
| | - D Smyth
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - D Jardine
- Department of General Medicine, Christchurch Hospital, Christchurch, New Zealand
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19
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Prakash S, Panchani N, Rathore C, Makwana P, Rathod M. Cardiac cephalalgia: First case from India. Ann Indian Acad Neurol 2016; 19:252-4. [PMID: 27293340 PMCID: PMC4888692 DOI: 10.4103/0972-2327.165467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A 67-year-old male smoker had exertional headaches for 2 years. The headaches were holocephalic, very severe, excruciating, and occasionally accompanied by nausea. Physical examinations and neuroimaging were normal. Electrocardiogram (ECG) showed old infarct in inferior leads. Sublingual nitrate provided relief in headaches. Stress test was positive with recurrence of similar headaches with ECG changes suggestive of myocardial ischemia. Coronary angiogram revealed three-vessel disease. Coronary artery bypass surgery provided complete resolution of headaches.
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Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Smt Bhikhiben Kantilal Shah Medical Institute and Research Centre Medical College, Waghodia, Vadodara, Gujarat, India
| | - Nirav Panchani
- Department of Cardiology, Smt Bhikhiben Kantilal Shah Medical Institute and Research Centre Medical College, Waghodia, Vadodara, Gujarat, India
| | - Chaturbhuj Rathore
- Department of Neurology, Smt Bhikhiben Kantilal Shah Medical Institute and Research Centre Medical College, Waghodia, Vadodara, Gujarat, India
| | - Prayag Makwana
- Department of Neurology, Smt Bhikhiben Kantilal Shah Medical Institute and Research Centre Medical College, Waghodia, Vadodara, Gujarat, India
| | - Mitali Rathod
- Department of Medicine, Smt Bhikhiben Kantilal Shah Medical Institute and Research Centre Medical College, Waghodia, Vadodara, Gujarat, India
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20
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Abstract
The prevalence of headache decreases in elderly age groups; however, headache remains a significant issue with unique diagnostic and therapeutic considerations in this population. While primary headache disorders such as migraine and tension-type headache still occur in the majority of cases, secondary headaches are more common with advancing age. Additionally, several rare primary headache disorders, such as hypnic headache and primary cough headache, occur more frequently in an elderly population and have distinct treatments. In this review, we provide an updated overview of the common, concerning, and unique headache disorders affecting the elderly.
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Affiliation(s)
- Thomas P Bravo
- Department of Neurology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA,
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21
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Huang CC, Liao PC. Heart Attack Causes Head-Ache - Cardiac Cephalalgia. ACTA CARDIOLOGICA SINICA 2016; 32:239-42. [PMID: 27122955 DOI: 10.6515/acs20150628a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
UNLABELLED Chest pain is the typical symptom of myocardial infarction (MI), and there are many atypical manifestations such as stomachache or dyspnea. Headache is a rare presentation of MI, which has specifically been termed "cardiac cephalalgia" or "cardiac cephalgia". In this article, we have reported a case of sudden onset headache and neck pain, of whom MI was confirmed by electrocardiography, cardiac markers, and coronary angiogram. The patient's headache subsided dramatically after coronary angioplasty, and it had not recurred in the following one year. Additionally, diagnostic clues and possible mechanisms of cardiac cephalalgia are discussed as well. KEY WORDS Headache • Cardiac cephalgia • Cardiac cephalalgia • Myocardial infarction.
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Affiliation(s)
- Chi-Cheng Huang
- Division of Cardiology, Cardiovascular Center, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Pen-Chih Liao
- Division of Cardiology, Cardiovascular Center, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
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22
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Nakagawa Y. Editorial: The first step of diagnosis is to know of the disease and question its presence, lessons from cardiac cephalalgia. J Cardiol Cases 2015; 11:142-143. [PMID: 30534264 PMCID: PMC6279678 DOI: 10.1016/j.jccase.2015.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Indexed: 11/16/2022] Open
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23
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24
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Chowdhury AW, Saleh MAD, Hasan P, Amin MG, Khan TA, Sabah KMN, Kabir SR. Cardiac cephalgia: A headache of the heart. J Cardiol Cases 2015; 11:139-141. [PMID: 30546551 DOI: 10.1016/j.jccase.2015.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 12/24/2022] Open
Abstract
Atypical presentations of common diseases are often difficult to identify in time, nonetheless necessary, especially in cases of diseases like ischemic heart disease (IHD) which otherwise may progress into irreversible stage and ultimately, fatality, in the absence of timely administered medical treatment. We report a case of a 51-year-old male, presenting initially with only headache as the sole symptom, who later was diagnosed with severe coronary artery disease, and the symptoms resolved completely after coronary angioplasty with stenting. <Learning objective: Atypical presentations, such as headache, can be more prevalent in ischemic heart disease (IHD) than was thought of, so awareness of the possibility of IHD while assessing headache and further study to see actually how commonly headache is associated with IHD are necessary.>.
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Affiliation(s)
| | | | - Pratyay Hasan
- Lakshmipasha Union Health and Family Welfare Centre, Golapganj, Sylhet, Bangladesh
| | | | | | - K M Nurus Sabah
- Department of Cardiology, Dhaka Medical College, Dhaka, Bangladesh
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25
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Abstract
Although most of the patients presenting with ischemic heart disease have chest pains, there are other rare presenting symptoms like cardiac cephalgia. In this report, we present a case of acute coronary syndrome with an only presentation of exertional headache. It was postulated as acute presentation of coronary artery disease, due to previous history of similar presentation associated with some chest pains with previous left coronary artery stenting. We present an unusual case with cardiac cephalgia in a young patient under the age of 50 which was not reported at that age before. There are four suggested mechanisms for this cardiac presentation.
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26
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Abstract
This article discusses headaches secondary to disorders of homeostasis, which include headaches attributed to (1) hypoxia and/or hypercapnia (high-altitude, diving, or sleep apnea), (2) dialysis, (3) arterial hypertension (pheochromocytoma, hypertensive crisis without hypertensive encephalopathy, hypertensive encephalopathy, preeclampsia or eclampsia, or autonomic dysreflexia), (4) hypothyroidism, (5) fasting, (6) cardiac cephalalgia, and (7) other disorder of homeostasis. Clinical features and diagnosis as well as therapeutic strategies are discussed for each headache type.
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Affiliation(s)
- Ana Marissa Lagman-Bartolome
- Division of Pediatric Neurology, Hospital for Sick Children, Women's College Hospital, University of Toronto, 555 University Avenue, Toronto, ON M5G1X8, Canada
| | - Jonathan Gladstone
- Gladstone Headache Clinic, 1333 Sheppard Avenue East, Suite 122, Toronto, ON M2J 1V1, Canada.
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27
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Affiliation(s)
- Luiz P. Queiroz
- Department of Neurology; Universidade Federal de Santa Catarina; Florianópolis Brazil
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28
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Abstract
Tension-type headache (TTH) is the most common form of headache in the general population. Diagnosis of TTH is based merely on clinical features and on careful exclusion of all possible causes of headache. Most of the headaches that present in the context of medical disorders (e.g., hypothyroidism, sleep disorders, and hypertensive crisis) have clinical features overlapping with those of TTH; medical history and specific features of the systemic disorder are usually the clues to establish a correct diagnosis. Some medical disorders may worsen a preexisting TTH, and is also possible the comorbidity of TTH with psychiatric disorders and fibromyalgia.
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30
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Providencia RA. Headache and cardiovascular disease: old symptoms, new proposals. Future Cardiol 2010; 6:703-23. [DOI: 10.2217/fca.10.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Evidence of a link between headache symptoms and cardiovascular disease has rapidly grown in recent years and it is of utmost importance for the cardiologist and neurologist to be aware of this intimate connection. A brief overview of different cardiovascular diseases (namely hypertension, stroke, coronary heart disease, patent foramen ovale, atrial septal defects, atrial septal aneurisms, mitral valve prolapse, and aortic and carotid disease) that may be related to headache is presented in this article. Proposed pathophysiological mechanisms for this association and landmark studies are reviewed and discussed.
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