Headache as a Presentation of Angina: Reproduction of Symptoms During Angioplasty

Abstract

We report a case of angina presenting as headache in a 59-year-old man. Headaches were relieved by nitroglycerin and were reproduced by occlusion of the first obtuse marginal artery during angioplasty. Headaches resolved after successful angioplasty. The temporal relationship between coronary artery occlusion and the headache suggests that headache angina is due to referred pain rather than a generalized vasospastic disorder.

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.…”

“…Eight patients had an acute myocardial infarction during the course of their headaches; 5 (63%) of these patients had both headache without concomitant chest pain and also headache not associated with exertion. The headaches resolved either permanently or temporarily with medical [5, 6, 8, 12, 14, 15, 17, 18], endovascular [1, 8, 10, 13, 17], or surgical [2, 3, 9, 14, 17]treatment if the cardiac ischemic events were not immediately life-threatening [12, 19]. Three patients died of ventricular fibrillation or acute myocardial infarction.…”

“…Five patients had accompanying nausea and/or vomiting, 2 reported photophobia and phonophobia, and 5 had pulsating headaches. Ten (48%) had other headaches not related to exertion [2, 3, 4, 5, 6, 11, 12, 13]. …”

Headache: An unusual presentation of acute myocardial infraction

“…The incidence of headache as a symptom of myocardial ischemia may be underestimated [1][2][3][4][5] . Culić et al [6] reported that headache is present (along with other symptoms) in 5.2% of patients with acute myocardial infarction.…”

“…Headache represents a rare symptom of myocardial ischemia [1][2][3][4][5] . We report a patient with ST-segment elevation acute myocardial infarction who presented to the emergency department complaining of headache without chest discomfort.…”