Primary Headache and Silent Myocardial Ischemia in Patients with Coronary Artery Disease

Abstract

Objective: The mechanisms by which migraine is linked to ischemic vascular disease remain uncertain and are likely to be complex. The aim of this study was to investigate the correlation between silent myocardial ischemia (SMI) and a history of documented primary headache in a large population of patients with exercise-induced myocardial ischemia. Methods: The study involved 1,427 consecutive patients (918 symptomatic and 509 asymptomatic patients) with exercise-induced myocardial ischemia and documented coronary artery disease (CAD). Results: Patients with anginal symptoms during exercise-induced myocardial ischemia had a significantly higher prevalence of primary headache than those without (41 vs. 30%, p < 0.001). Patients with angina pectoris in daily life also had greater prevalence of primary headache than those without anginal symptoms (37 vs. 20%; p < 0.0001). Symptomatic patients during percutaneous transluminal coronary angiography or myocardial infarction had a greater prevalence of primary headache than asymptomatic patients (p < 0.001 and p = 0.005, respectively). Conclusions: Our data suggest that a history of headache in CAD population is correlated to a high probability of anginal symptoms and a decreased probability of SMI. The anamnestic absence of headache requires a close monitoring for patients with risk factors for CAD, because this population seems to have a lower susceptibility to pain and the risk of developing SMI might be increased.

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.…”

Correlation between Migraine and Cardiovascular Disease: State of Art

“…A recent work on a large CAD population by Falcone C et al, (2013) [10] suggests that the presence of primary headache could be a useful marker to identify subjects with susceptibility to pain and that its absence could be correlated with SMI. Data deriving by this study suggest that symptomatic patients with primary headache were more prone to pain.…”

“…In multiple population-based studies was shown that patients with migraine are more likely to have chest pain symptoms [8][9][10]. Among which one large study in Australian patients showed a relationship between migraine and cardiovascular events and noted that subjects with migraine were twice as likely to have a self-reported history of myocardial infarction [11].…”

Headache: An unusual presentation of acute myocardial infraction

“…Atypical symptoms of myocardial infarction may delay the diagnosis, and therefore the proper management to rescue ischemic myocardium. 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.…”