Headache and heart disease
Some patients with episodic headaches could have myocardial ischemia.
NEW YORK, September 19 (Praxis Press). The pain caused by myocardial ischemia may be referred to the neck, jaw, epigastrium and arms; when referred cardiac pain is perceived as a headache, it is usually accompanied by typical angina. In this week's issue of the Lancet, Lanza and colleagues reported an unusual pattern of cardiac pain in a 68-year-old man. The patient presented with a three-year history of brief occipital headaches that occurred at rest; his medical history was significant for two cardiovascular risk factors (smoking and hypercholesterolemia). During a typical headache, laboratory tests revealed elevated levels of creatine kinase, creatine kinase-MB and troponin I, although the results of an electrocardiogram and electrocardiography were normal. An exercise test precipitated the headache and T-wave peaking, which resolved with sublingual nitrates. Angiography revealed 90% occlusion of the left anterior descending coronary artery, 90% occlusion of the left circumflex coronary artery and complete occlusion of the right coronary artery. The patient underwent coronary artery bypass graft surgery and has remained free of headache for three years. The authors recommend a high degree of clinical suspicion of myocardial ischemia in patients with episodic headaches affecting any region of the head, particularly when a headache is triggered by exercise and relieved by nitrates, and when a patient has cardiovascular risk factors.