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Cardiac cephalgia: a treatable form of exertional headache
R B Lipton1, T Lowenkopf, Z H Bajwa
1Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
Insights
Exertional headaches can be a rare symptom of underlying heart conditions like myocardial ischemia. Prompt diagnosis and treatment, such as myocardial revascularization, can resolve these headaches and prevent heart attacks.
Area of Science:
- Cardiology
- Neurology
- Exercise Physiology
Background:
- Exertional headaches are headaches triggered by physical activity.
- While often benign, they can sometimes indicate serious underlying conditions.
Observation:
- Two patients presented with exertional headaches linked to vigorous exercise.
- Headaches resolved with rest and correlated with ECG changes during stress tests.
- Neurologic evaluations and neuroimaging were normal.
Findings:
- Coronary angiography revealed three-vessel disease in both patients.
- Myocardial revascularization procedures led to complete headache resolution.
- Myocardial ischemia is identified as a rare cause of exertional headaches.
Implications:
- Accurate diagnosis of exertional headaches is crucial.
- Identifying myocardial ischemia as a cause can prevent both headaches and myocardial infarction.
- This highlights the importance of considering cardiac causes for exertional symptoms.
Abstract:
We report two patients with exertional headaches beginning with vigorous exercise and relieved by rest. Neurologic evaluation and neuroimaging were normal in both. During exercise stress testing, the onset of the patients' typical headaches correlated with ECG changes indicative of myocardial ischemia. In both patients coronary angiography revealed three-vessel disease, and myocardial revascularization procedures were followed by complete resolution of headaches. Based on these patients, and a review of prior similar reports, we conclude that myocardial ischemia is a rare and treatable cause of exertional headache. Accurate diagnosis is critical to controlling headaches and preventing myocardial infarction.