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Cardiac cephalalgia: First case from India
Sanjay Prakash1, Nirav Panchani2, Chaturbhuj Rathore1
1Department of Neurology, Smt Bhikhiben Kantilal Shah Medical Institute and Research Centre Medical College, Waghodia, Vadodara, Gujarat, India.
Annals of Indian Academy of Neurology
|June 14, 2016
Summary
Exertional headaches in a male smoker were linked to coronary artery disease. Successful coronary artery bypass surgery completely resolved these cardiac-related headaches.
Area of Science:
- Cardiology
- Neurology
- Cardiovascular Surgery
Background:
- Coronary artery disease (CAD) can manifest with atypical symptoms.
- Exertional headaches are a rare but potential symptom of underlying cardiac ischemia.
Observation:
- A 67-year-old male smoker presented with a 2-year history of severe, holocephalic exertional headaches, nausea, and a history of myocardial infarction.
- Physical examinations and neuroimaging were unremarkable, but electrocardiogram (ECG) revealed old inferior infarcts.
- Sublingual nitrate administration provided temporary headache relief.
Findings:
- A positive stress test reproduced the headaches and showed ECG changes indicative of myocardial ischemia.
- Coronary angiography identified significant three-vessel disease.
- Coronary artery bypass surgery resulted in complete resolution of the exertional headaches.
Implications:
- This case highlights the importance of considering cardiac ischemia in patients with exertional headaches, even with normal neurological findings.
- Early diagnosis and intervention for coronary artery disease can effectively manage associated symptoms like exertional headaches.
- Integrated cardiovascular and neurological assessment is crucial for complex presentations involving exertional symptoms.
