March 17, 2020, e-Pearl of the Week: Cardiac cephalgia

Cardiac cephalgia

Cardiac cephalgia (CC) is a rare type—36 reported cases—of secondary exertional headache precipitated by myocardial ischemia.1 CC presents as multifocal and throbbing, and it is accompanied by nausea in the absence of chest pain.2,3 CC is associated with vascular risk factors such as hypertension, hyperlipidemia, and personal and family history of diabetes mellitus. CC headache severity parallels that of myocardial ischemia.2 CC is a clinical diagnosis, and neurovascular imaging is unremarkable. Differential diagnosis includes migraines, reversible cerebral vasoconstriction syndrome, and vertebral dissection. Nitrates relieve the headaches acutely; however, definite treatment would be to rectify the cardiac ischemia. Use of vasoconstrictors—such as triptans and ergots—is contraindicated due to adverse cardiac outcomes.3

References

  1. Wang M, Wang L, Liu C, et al. Cardiac cephalalgia: one case with cortical hypoperfusion in headaches and literature review. J Headache Pain 2017;18:24.
  2. Chowdhury AW, Saleh MAD, Hasan P, et al. Cardiac cephalgia: A headache of the heart. J Cadiol Cases 2015;11:139–141.
  3. Wassef N, Ali AT, Katsanevaki AZ, Nishtar S. Cardiac Cephalgia. Cardiol Res 2014;5:195–197.

Submittted by Ekene Okolo, MD, Research Associate, Sugarland Neurology and Sleep, and Faisal Khan, MD, DABSM, DABPN, Consultant Neurologist, Sugarland Neurology and Sleep, Texas

Ekene Okolo and Dr. Khan report no disclosures.