Pacemaker headaches

A symptom complex (pacemaker syndrome) consisting of hypotension, dizziness, or near-syncope in patients with functioning ventricular pacemakers has been previously described. Whereas, the effects of synchronized ventriculo-atrial contraction on forward systemic circulation are known, the effects of increased venous dynamics on systemic function are not known. We describe a patient who developed severe headaches during periods of ventricular pacing with retrograde ventriculo-atrial conduction. These headaches occurred in the absence of symptoms of Pacemaker syndrome or of changes in systemic blood pressure. We believe that the headaches were caused by alterations in intracranial pressure from exaggerated pulsatile venous dynamics. Conversion of the pacing system from VVI to AV sequential pacing completely relieved the headaches.