[Headache: a rare manifestation of angina pectoris]

Typical angina pectoris rarely produces pain above the mandible. We report a patient with exertional headache, which was relieved by nitrates and revascularisation. The explanation is speculative; 1) anatomic convergence of cardiac nerve fibres and somatic efferents from the head; 2) increased intracranial pressure secondary to decreased cardiac output during ischaemia; and 3) unidentified headache eliciting mediators released by cardiac ischaemia. We conclude that headache may be a (the only) manifestation of myocardial ischaemia. The suspicion should arise, if the headache is exercise-induced and relieved by nitrates.