Cardiac cephalalgia: a case series of four patients and updated literature review
Abstract Background Cardiac damage is common in patients with acute brain injury; however, little is known regarding cardiac-induced neurological symptoms. In the International Classification of Headache, Third Edition (ICHD-III), cardiac cephalalgia is classified as a headache caused by impaired ho...
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | International Journal of Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s12245-022-00436-2 |
| _version_ | 1811222397458579456 |
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| author | Hitoshi Kobata |
| author_facet | Hitoshi Kobata |
| author_sort | Hitoshi Kobata |
| collection | DOAJ |
| description | Abstract Background Cardiac damage is common in patients with acute brain injury; however, little is known regarding cardiac-induced neurological symptoms. In the International Classification of Headache, Third Edition (ICHD-III), cardiac cephalalgia is classified as a headache caused by impaired homeostasis. Methods This report presents four patients with acute myocardial infarction (AMI) who presented with headache that fulfilled the ICHD-III diagnostic criteria for cardiac cephalalgia. A systematic review of cardiac cephalalgia using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines is also presented. Results Case 1: A 69-year-old man with a history of percutaneous coronary intervention (PCI) developed sudden severe occipital pain, nausea, and cold sweating. Coronary angiography (CAG) revealed occlusion of the right coronary artery (RCA). Case 2: A 66-year-old woman complained of increasing occipitalgia and chest discomfort while riding a bicycle. CAG demonstrated 99% stenosis of the left anterior descending artery. Case 3: A 54-year-old man presented with faintness, cold sweating, and occipitalgia after eating lunch. CAG detected occlusion of the RCA. Case 4: A 72-year-old man went into shock after complaining of a sudden severe headache and nausea. Vasopressors were initiated and emergency CAG was performed, which detected three-vessel disease. In all four, electrocardiography (ECG) showed ST segment elevation or depression and echocardiography revealed a left ventricular wall motion abnormality. All patients underwent PCI, which resulted in headache resolution after successful coronary reperfusion. A total of 59 cases of cardiac cephalalgia were reviewed, including the four reported here. Although the typical manifestation of cardiac cephalalgia is migraine-like pain on exertion, it may present with thunderclap headache without a trigger or chest symptoms, mimicking subarachnoid hemorrhage. ECG may not always show an abnormality. Headaches resolve after successful coronary reperfusion. Conclusions Cardiac cephalalgia resulting from AMI can present with or without chest discomfort and even mimic the classic thunderclap headache associated with SAH. It should be recognized as a neurological emergency and treated without delay. |
| first_indexed | 2024-04-12T08:15:10Z |
| format | Article |
| id | doaj.art-0ae16bb68c2b45ed93a0d5e34c178576 |
| institution | Directory Open Access Journal |
| issn | 1865-1372 1865-1380 |
| language | English |
| last_indexed | 2024-04-12T08:15:10Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Emergency Medicine |
| spelling | doaj.art-0ae16bb68c2b45ed93a0d5e34c1785762022-12-22T03:40:48ZengBMCInternational Journal of Emergency Medicine1865-13721865-13802022-07-0115111510.1186/s12245-022-00436-2Cardiac cephalalgia: a case series of four patients and updated literature reviewHitoshi Kobata0Osaka Mishima Emergency Critical Care CenterAbstract Background Cardiac damage is common in patients with acute brain injury; however, little is known regarding cardiac-induced neurological symptoms. In the International Classification of Headache, Third Edition (ICHD-III), cardiac cephalalgia is classified as a headache caused by impaired homeostasis. Methods This report presents four patients with acute myocardial infarction (AMI) who presented with headache that fulfilled the ICHD-III diagnostic criteria for cardiac cephalalgia. A systematic review of cardiac cephalalgia using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines is also presented. Results Case 1: A 69-year-old man with a history of percutaneous coronary intervention (PCI) developed sudden severe occipital pain, nausea, and cold sweating. Coronary angiography (CAG) revealed occlusion of the right coronary artery (RCA). Case 2: A 66-year-old woman complained of increasing occipitalgia and chest discomfort while riding a bicycle. CAG demonstrated 99% stenosis of the left anterior descending artery. Case 3: A 54-year-old man presented with faintness, cold sweating, and occipitalgia after eating lunch. CAG detected occlusion of the RCA. Case 4: A 72-year-old man went into shock after complaining of a sudden severe headache and nausea. Vasopressors were initiated and emergency CAG was performed, which detected three-vessel disease. In all four, electrocardiography (ECG) showed ST segment elevation or depression and echocardiography revealed a left ventricular wall motion abnormality. All patients underwent PCI, which resulted in headache resolution after successful coronary reperfusion. A total of 59 cases of cardiac cephalalgia were reviewed, including the four reported here. Although the typical manifestation of cardiac cephalalgia is migraine-like pain on exertion, it may present with thunderclap headache without a trigger or chest symptoms, mimicking subarachnoid hemorrhage. ECG may not always show an abnormality. Headaches resolve after successful coronary reperfusion. Conclusions Cardiac cephalalgia resulting from AMI can present with or without chest discomfort and even mimic the classic thunderclap headache associated with SAH. It should be recognized as a neurological emergency and treated without delay.https://doi.org/10.1186/s12245-022-00436-2Cardiac cephalalgiaCardiac cephalgiaAcute myocardial ischemiaThunderclap headacheNeurological Emergency |
| spellingShingle | Hitoshi Kobata Cardiac cephalalgia: a case series of four patients and updated literature review International Journal of Emergency Medicine Cardiac cephalalgia Cardiac cephalgia Acute myocardial ischemia Thunderclap headache Neurological Emergency |
| title | Cardiac cephalalgia: a case series of four patients and updated literature review |
| title_full | Cardiac cephalalgia: a case series of four patients and updated literature review |
| title_fullStr | Cardiac cephalalgia: a case series of four patients and updated literature review |
| title_full_unstemmed | Cardiac cephalalgia: a case series of four patients and updated literature review |
| title_short | Cardiac cephalalgia: a case series of four patients and updated literature review |
| title_sort | cardiac cephalalgia a case series of four patients and updated literature review |
| topic | Cardiac cephalalgia Cardiac cephalgia Acute myocardial ischemia Thunderclap headache Neurological Emergency |
| url | https://doi.org/10.1186/s12245-022-00436-2 |
| work_keys_str_mv | AT hitoshikobata cardiaccephalalgiaacaseseriesoffourpatientsandupdatedliteraturereview |