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Pacemaker implantation for treating migraine-like headache secondary to cardiac arrhythmia: A case report
Yu-Hong Man1, Xiao-Li Meng, Ting-Min Yu
1Department of Neurology, The Second Hospital of Jilin University, Changchun, China.
Insights
Cardiac arrhythmia can cause migraine-like headaches. Pacemaker implantation successfully treated a patient
Area of Science:
- Cardiology
- Neurology
Background:
- Headache and arrhythmia frequently co-occur, but a causal link is not well-established.
- This study explores a potential relationship between cardiac arrhythmias and secondary migraine-like headaches.
Observation:
- A 63-year-old woman presented with migraine-like headaches and visual aura.
- Cardiac evaluation revealed bradycardia, ventricular premature beats, and supraventricular tachycardia.
- Cerebral angiography showed a carotid artery bifurcation lesion.
Findings:
- The patient's migraine-like headaches and visual aura resolved completely after pacemaker implantation.
- This suggests a direct causal link between the diagnosed cardiac arrhythmia and the headache symptoms.
Implications:
- This case report is the first to describe migraine-like headaches as a secondary symptom of cardiac arrhythmia.
- Pacemaker implantation may serve as a definitive treatment for such cases, particularly when co-existing with cerebrovascular lesions.
- Highlights the importance of cardiac evaluation in patients with refractory migraine-like headaches.
Rationale:
Co-occurrence of headache and arrhythmia is not rare. However, their causal relationship remains unclear. Here, we described a case of migraine-like headache relieving with pacemaker implantation. Our case study indicates that arrhythmia is causal for migraine-like headache, which, to our knowledge, has never been reported.
Patient Concerns:
A 63-year-old woman patient suffered from paroxysmal headache with a visual aura presenting like migraine for 2 years. No ophthalmic or neurological disorder was found, but cardiac examination detected bradycardia, which was confirmed by 24-hour dynamic electrocardiogram (DCG) revealing sinus bradycardia mixed with ventricular premature beats and supraventricular tachycardia. Transcranial doppler (TCD) detected an equal echo flat plaque on the anterolateral wall of the common carotid artery (CA) bifurcation.
Diagnosis:
Migraine-like headaches secondary to arrhythmia.
Interventions:
The patient underwent pacemaker implantation.
Outcomes:
Both visual aura and headache were resolved following pacemaker implantation.
Lessons:
To the best of the authors' knowledge, we are the first to report migraine-like headache as a secondary symptom of arrhythmia. Arrhythmia may aggravate insufficient blood supply to the brain due to CA lesion and induce a migraine-like headache. This case study indicated that pacemaker implantation could be a fundamental treatment for migraine-like headaches caused by cardiac arrhythmia.
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