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A possible relationship between migraine and coronary artery spasm
Insights
Migraine patients experiencing chest pain may have coronary artery spasm, a vasospastic disorder. Ergotamine use is contraindicated, and calcium channel blockers can effectively treat these symptoms.
Area of Science:
- Cardiology
- Neurology
Background:
- Migraine headaches are common, particularly in women.
- Ischemic chest pain can have various causes, including coronary artery spasm.
Observation:
- Five women in their 50s with a history of migraine presented with ischemic chest pain.
- Four patients experienced angina at rest with electrocardiographic changes.
- Three patients had myocardial infarction, one after ergotamine tartrate use.
Findings:
- Coronary angiography revealed no atherosclerotic disease, suggesting vasospasm as the cause of ischemia.
- Chest pain in migraineurs may indicate coronary artery spasm, linked to a generalized vasospastic disorder.
- Ergot preparations can exacerbate chest pain and lead to myocardial infarction in these patients.
Implications:
- Concurrent electrocardiograms are recommended for migraine patients with chest pain to investigate potential coronary artery spasm.
- Calcium channel blockers are an effective treatment for chest pain related to coronary artery spasm in migraineurs.
- Contraindicating ergot preparations in patients with migraine and chest pain is crucial to prevent adverse cardiac events.
Abstract:
Five patients, all women in their 50s and all with a documented history of migraine headaches, had ischemic chest pains investigated. Four patients had angina primarily occurring at rest, with documented ischemic electrocardiographic changes during pain in all five. Three subjects sustained myocardial infarction, one shortly after taking ergotamine tartrate for an acute attack of migraine. Subsequent coronary angiography in all five subjects revealed no evidence of atherosclerotic coronary artery disease, suggestive of spasm as the cause of ischemia. In subjects with known migraine, the occurrence of chest pain may represent coronary artery spasm, and should be investigated with concurrent electrocardiographs, as these two clinical entities may be related as part of a generalised vasospastic disorder. The use of ergot preparations should be contraindicated in such patients, as exacerbation of chest pain and frank myocardial infarction may result. These chest pains responded favourably to calcium channel blockers.