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Cardiac cephalgia.

Annamaria Bini1, Andrea Evangelista, Paola Castellini

  • 1Department of Neuroscience, Headache Centre, University of Parma, Parma, Italy. bini.annamaria@alice.it

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Cardiac cephalgia, a rare secondary headache, may be the sole indicator of an ischemic cardiovascular event. Diagnosis can be challenging due to variable symptoms and negative initial tests, often requiring coronary angiography.

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Area of Science:

  • Neurology
  • Cardiology
  • Emergency Medicine

Background:

  • Cardiac cephalgia is classified as a secondary headache (ICD-10 code 10.6) linked to homeostatic disorders.
  • It is often an underdiagnosed condition, potentially being the only presenting symptom of an acute coronary event in 27% of cases.
  • This headache type typically arises post-exertion and can present with diverse, non-specific clinical features.

Purpose of the Study:

  • To critically evaluate the existing medical literature on cardiac cephalgia.
  • To highlight the diagnostic challenges and clinical variability associated with this condition.
  • To increase awareness of cardiac cephalgia as a potential indicator of ischemic cardiovascular events.

Main Methods:

  • Comprehensive review of medical literature concerning cardiac cephalgia.
  • Analysis of diagnostic criteria and clinical presentations.
  • Examination of cases where headache was the sole manifestation of cardiac events.

Main Results:

  • Cardiac cephalgia presents with high variability, mimicking migraine or tension-type headaches.
  • Routine cardiac investigations (enzymes, ECG, stress tests) can be negative, necessitating coronary angiography for definitive diagnosis.
  • Key indicators for suspicion include older age, no prior headache history, vascular risk factors, and exertional onset.

Conclusions:

  • Cardiac cephalgia is a challenging diagnosis due to its mimicry of primary headaches and variable presentation.
  • Increased clinical suspicion and awareness are crucial, especially in patients with cardiovascular risk factors presenting with new-onset exertional headaches.
  • Further research and recognition are needed to improve the understanding and management of this potentially life-threatening condition.