Acute migraine attack, angina-like chest pain with documented ST-segment elevation and slow coronary flow

Slow flow of dye in epicardial coronary arteries is not an infrequent finding in patients during routine coronary angiography. The coronary slow flow phenomenon is an angiographic finding characterized by delayed distal vessel opacification in the absence of significant epicardial coronary artery disease. It is speculated that coronary slow flow is a new disease characterized by acute but recurrent perturbations of microvascular function. There are many theories concerning the pathogenesis of migraine. The clinical effectiveness of vasoactive drugs and many investigations on the cerebral blood flow in patients with migraine, strongly support a vascular theory. The relationship between migraine and cardiopathy has not been sufficiently established and controversy exists concerning its favouring role in coronary artery disease. We report a case of an acute migraine attack in a patient who uses triptans (5-HT(1B/1D) receptor agonists). The attack was accompanied by angina-like chest pain with documented ST-segment elevation and slow coronary flow in the absence of any significant obstructive coronary artery disease and no evidence of any major epicardial coronary arterial spasm.