Prevalence, clinical characteristics and associated factors of cardiac cephalalgia: A prospective study

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.

Evaluation of the ICHD-3 diagnostic criteria for cardiac cephalalgia and new proposal

“…In relation to criterion C3, studies have shown that headache characteristics in patients with cardiac cephalalgia are very variable (4–6) and the compliance rate of some of the sub-criteria, especially C3b and C3d, is low. For this reason and to simplify the diagnostic criteria, we suggest that criterion C3 should be removed.…”

“…We conducted a series of cases study of 54 patients with cardiac cephalalgia identified in a prospective study of consecutive patients admitted to the Cardiology Service at Hospital Cl ınico Universitario Lozano Blesa in Zaragoza, Spain, with suspected acute coronary syndrome (ACS) from January 2021 and January 2022 (6). A complete description of material and methods has been given elsewhere (6).…”

“…However, our results showed that, in most cases (87%), headache and ACS symptoms started simultaneously and, in all patients except one (98,1%), headache started within 1 h before ACS symptoms. For this reason, we think that it is important to specify in criterion C1 that headache develops in In relation to criterion C3, studies have shown that headache characteristics in patients with cardiac cephalalgia are very variable (4)(5)(6) and the compliance rate of some of the sub-criteria, especially C3b and C3d, is low. For this reason and to simplify the diagnostic criteria, we suggest that criterion C3 should be removed.…”

“…Furthermore, cardiac cephalalgia is described in the ICHD-3 as a migraine-like headache. However, it is possible that this definition is not correct because throbbing quality was present only in 13.8% of previous case reports (5), with unilateral headache in 12.1%, and the absence of photo and phonophobia is a criterion of cardiac cephalalgia (sub-criterion C3b), but at least one of them is present in 18.5% of cases (6).…”