Cardiac Headache: Hemicranial Cephalalgia as the Sole Manifestation of Coronary Ischemia

Martínez, Héctor R.; Rangel-Guerra, Ricardo; Cantú‐Martínez, Leonel; Garza‐Gómez, Jorge; González, Humberto C.

doi:10.1046/j.1526-4610.2002.02233.x

Cited by 17 publications

(18 citation statements)

References 13 publications

(54 reference statements)

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“…Symptoms related to the underlying disorder, such as chest constriction, pain in the left arm radiating up to the mandible, or epigastric pain, are present in around half of the reported cases. In some patients, cardiac cephalalgia is the only manifestation of a cardiovascular ischemic event [20]. The recognition of myocardial ischemia as the cause of headache is important in clinical practice.…”

Section: Medical Disorders and Tension-type Headachementioning

confidence: 99%

Tension-type Headache and Systemic Medical Disorders

Sacco

Ricci

Carolei

2011

Curr Pain Headache Rep

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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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Section: Medical Disorders and Tension-type Headachementioning

confidence: 99%

Tension-type Headache and Systemic Medical Disorders

Sacco

Ricci

Carolei

2011

Curr Pain Headache Rep

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“…As it is associated to a cardiovascular event, cardiac cephalgia generally occurs after the fifth decade of life in subjects at risk for cardiovascular disease who may not have previously suffered from headache [4–11]. …”

Section: Clinical Featuresmentioning

confidence: 99%

Cardiac cephalgia

et al. 2009

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The purpose of this review was to provide a critical evaluation of medical literature on so-called “cardiac cephalgia” or “cardiac cephalalgia”. The 2004 International Classification of Headache Disorders codes cardiac cephalgia to 10.6 in the group of secondary headaches attributed to disorder of homoeostasis. This headache is hardly recognizable and is associated to an ischaemic cardiovascular event, of which it may be the only manifestation in 27% of cases. It usually occurs after exertion. Sometimes routine examinations, cardiac enzymes, ECG and even exercise stress test prove negative. In such cases, only a coronary angiogram can provide sufficient evidence for diagnosis. Cardiac cephalgia manifests itself without a specific pattern of clinical features: indeed, in this headache subtype there is a high variability of clinical manifestations between different patients and also within the same patient. It “mimics” sometimes a form of migraine either accompanied or not by autonomic symptoms, sometimes a form of tension-type headache; on other occasions, it exhibits characteristics that can hardly be interpreted as typical of primary headache. Pain location is highly variable. When the headache occurs as the only manifestation of an acute coronary event, the clues for suspicion are a) older age at onset, b) no past medical history of headache, c) presence of risk factors for vascular disorders and d) onset of headache under stress. Knowledge of cardiac cephalgia is scarce, due to its rare clinical occurrence and to the scant importance given to headache as a symptom concomitantly with an ischaemic cardiac event.

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“…A headache that occurs during exertion or responds to nitrates, especially in elderly patients with cardiovascular risk factors and no history of neurologic disease, should raise the possibility of cardiac origin. 13,20 In the case of an acute headache of prolonged duration that occurs during rest and is associated with ischemic-like electrocardiographic abnormalities, it is difficult to establish a rapid and correct diagnosis. The exclusion of an acute intracranial event should direct the clinician to the potential diagnosis of an acute coronary syndrome.…”

Section: Resultsmentioning

confidence: 99%

“…The greatest incidence was observed in anterior infarctions (4.5%) and the lowest in lateral (2.1%). Even though the occurrence of headache as a sole manifestation of angina [8][9][10][11][12][13] or myocardial infarction [14][15][16][17] has been previously described, many clinicians ignore this unusual manifestation.…”

Section: Discussionmentioning

confidence: 99%

Acute Non-ST-Elevation Myocardial Infarction Presented as Occipital Headache with Impaired Level of Consciousness

et al. 2005

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Headache represents a rare manifestation of myocardial ischemic pain. It is believed that this clinical symptom results from convergence of heart autonomic fibers with somatic inputs originating from the head. The authors describe for the first time the case of a 73-year-old woman who experienced an acute non-ST-elevation myocardial infarction that manifested solely with intense occipital headache associated with vomiting and impaired level of consciousness. This unusual case highlights that the exclusion of an intracranial event in patients presenting with a severe headache and ischemic-like electrocardiographic abnormalities should raise the possibility of an acute coronary event, especially in elderly individuals with cardiovascular risk factors. Furthermore, the occurrence of episodic short-lasting headaches during exertion should direct diagnostic work-up toward ischemic heart disease.

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Cardiac Headache: Hemicranial Cephalalgia as the Sole Manifestation of Coronary Ischemia

Cited by 17 publications

References 13 publications

Tension-type Headache and Systemic Medical Disorders

Tension-type Headache and Systemic Medical Disorders

Cardiac cephalgia

Acute Non-ST-Elevation Myocardial Infarction Presented as Occipital Headache with Impaired Level of Consciousness

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