Walk Headache: An Unusual Manifestation of Ischemic Heart Disease

Abstract

A 71 year old man sought neurological advice because for two years he had suffered from headache every time he made an effort. A treadmill stress test showed a relation between effort, headache and depression of ST segments on E.C.G. With isosorbide dinitrate and diltiazem, the manifestations improved. This suggests a referred head pain due to myocardial ischemia.

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.…”

“…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]. …”

“…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.…”

“…Aside from our case, however, cardiac cephalalgia did recur in 2 other patients. One still experienced headache on great exertion [11], and the other had headache recurrence 7 years later because of reocclusion of the coronary arteries; this headache persisted despite repeated bypass surgery [17]. As atherosclerosis is an on-going disease process, the coronary arteries might become reoccluded after effective medical therapy or coronary revascularization.…”

A Case of Cardiac Cephalalgia Showing Reversible Coronary Vasospasm on Coronary Angiogram

“…The convergence of cardiac nerve fibers on central pathways receiving somatic afferents from the head is likely to be responsible for the perception of cardiac ischemic pain as headache 1. Several reports have implicated headache, both with3-5 and without4,6 chest pain, as a clinical manifestation of coronary ischemia. In all previous reports, effect of continuous electrocardiography (ECG)-based testing was abnormal.…”