Paroxysmal Toothache after Drinking: Alcohol-Induced Vasospastic Angina

A 68-year-old Japanese man presented with recurrent paroxysmal toothache exclusively after alcohol consumption. The episodes occurred 2-3 hours after drinking, lasted 10-15 minutes, and were unrelated to exertion or eating, chewing, or brushing the teeth. Physical examination and laboratory tests were unremarkable. Vasospastic angina was suspected based on the episodic nature and association with alcohol. Symptoms resolved within 1-2 minutes of nitroglycerin administration, confirming the diagnosis of alcohol-induced vasospastic angina. This case highlights the importance of considering cardiac causes, including vasospastic angina, in patients with unexplained paroxysmal symptoms such as toothache, especially when triggered by alcohol consumption.

Vasospastic angina is caused by transient abnormal contraction of the coronary arteries. Episodes last for 5-15 minutes and are most common in the late evening and early morning.In some patients with vasospastic angina, attacks occur only on drinking days, several hours after drinking. Alcohol-induced vasospastic angina is thought to be attributable to a functional disorder of vascular smooth muscle caused by acetaldehyde accumulation due to alcohol metabolism or transient coronary artery spasm associated with magnesium deficiency and increased endothelin-1 activity.Vasospastic angina can manifest as pain in the head and neck, teeth, arms and shoulders, and is often accompanied by chest pain. However, toothache can be the only symptom and is often bilateral, as in this case.