Cardiac cephalgia: A treatable form of exertional headache

Abstract

We report two patients with exertional headaches beginning with vigorous exercise and relieved by rest. Neurologic evaluation and neuroimaging were normal in both. During exercise stress testing, the onset of the patients' typical headaches correlated with ECG changes indicative of myocardial ischemia. In both patients coronary angiography revealed three-vessel disease, and myocardial revascularization procedures were followed by complete resolution of headaches. Based on these patients, and a review of prior similar reports, we conclude that myocardial ischemia is a rare and treatable cause of exertional headache. Accurate diagnosis is critical to controlling headaches and preventing myocardial infarction.

Cardiac Cephalalgia

“…Twenty-one patients [1, 2, 3, 4, 5, 6, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19]were found in this review. Findings in 22 patients (including ours) including headache features, associated myocardial ischemia, and the presence or absence of each criterion of the ICHD-II criteria for cardiac cephalalgia are summarized in table 1.…”

“…One-half of the patients had received exercise stress tests [1, 2, 9, 10, 11, 14, 15, 16, 17]in which the headache was successfully reproduced. Coronary angiography was performed in 14 patients.…”

“…Cardiac cephalgia is a rare condition and was first proposed by Lipton et al [1]in 1997. In their report, this kind of headache was exclusively exertional.…”

Angina Cranialis: An Unusual Presentation of Referred Ischemic Myocardial Pain

“…The variations in the locations of cardiac referred pain were therefore attributed to the variations in these somatic convergences, either ascent or descent of the neural convergence between the somatic sensory fibers and the autonomic afferents from the heart; so called "overflow of usual neural convergence" [4]. For example, the referred cardiac pain can occur at vertex, orbit, bregma, nasal tip, frontal and peri-oral areas in cases of ascending convergence to involve descending sensory fibers of trigeminal nerve in brain stem as in this reported case, or at epigastrium and peri-umbilical areas in cases of descending neural convergence [5][6][7] (Fig. 1).…”

Cardiac headache in acute coronary syndrome

“…[3] Other reports describe exertional headache, similar to exertional angina in patients with known CAD and myocardial infarctions. [4,5] Additional rare cases of patients presenting with headache as the sole symptom during myocardial infarction have been described primarily in elderly male patients, sometimes with initially normal EKG's. [6][7][8][9][10] The pathophysiology behind headache symptomatology during acute myocardial infarction (MI) has yet to be clearly reported.…”