Cardiac Cephalgia as a Manifestation of Acute Coronary Events: A Systematic Review

Acute coronary syndromes often have atypical presentations, especially in female and elderly populations, leading to considerable diagnostic challenges. Cardiac cephalgia (CC), or headache caused by myocardial ischemia, is a rare and often neglected manifestation, a situation that deserves the interest of medical professionals. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines to synthesize available literature on this intriguing phenomenon. A thorough search was conducted on six databases: PubMed, SCOPUS, Web of Science, ProQuest, Google Scholar, and EBSCO, targeting papers published between 2000 and 2023. Ten peer-reviewed studies met the inclusion criteria, including randomized controlled trials, cohort studies, and case reports, with a total participant pool of 80,202. Several emergent themes were noted: the potential for CC to be the only symptom of ischemia, diagnostic misattributions to primary headache disorders, and clinical resolution noted following nitrate therapy or coronary interventions. Notwithstanding the narrow breadth of available evidence, which stems mainly from case reports, the findings suggest that clinicians must maintain a high index of suspicion for CC in patients who present with unexplained headaches and cardiovascular risk factors. Contemporary clinical guidelines rarely recognize this presentation, and additional prospective studies are necessary to develop diagnostic criteria and incorporate cardiac investigations into headache evaluation protocols.