Effects of endurance exercise on serum concentration of calcitonin gene-related peptide (CGRP): a potential link between exercise intensity and headache

BackgroundCalcitonin gene-related peptide (CGRP) is a powerful neuropeptide that is strongly involved in headache pain pathogenesis by triggering vasodilation, mast cell degranulation and neurogenic inflammation. This evidence has prompted us to investigate the acute influence of endurance exercise on CGRP concentration in blood.MethodsThe study population consisted of 48 male amateur runners, who ran a half-marathon distance at 75%–85% of maximal oxygen uptake. Blood was drawn before the run (pre-run) and immediately after each runner ended his trial (post-run). The serum concentration of CGRP was measured with a commercial enzyme-linked immunosorbent assay (ELISA) technique.ResultsOverall, 22/48 subjects (45.8%) reported suffering from headache, three of whom (6.2%) had an exertional headache, whilst 26/48 (54.2%) subjects did not report at least one headache episode during the previous 6 months (i.e. headache-free). All 48 athletes successfully covered the 21.1 km distance. Serum concentration of CGRP significantly increased by 1.5-fold in the entire group, as well as in the headache-positive and headache-free cohorts. Univariate Spearman’s correlation revealed that post-run variation of serum CGRP was significantly and inversely associated with running time (r = −0.30; p = 0.036).ConclusionsThe serum concentration of CGRP is significantly enhanced by medium-distance endurance exercise and the post-exercise increase is dependent on running intensity. Accordingly, high-exercise intensity might be directly related to triggering both exertional headache and/or migraine episodes.

Exertional and sex headache

Exertional headache and sexual headache are headache disorders that share some clinical and pathophysiological characteristics. These two headache disorders are both provoked by specific triggers and are highly comorbid with migraine. They account for a small proportion of headache consultations, but potentially devastating secondary causes such as subarachnoid haemorrhage or reversible cerebral vasoconstriction syndromes should be considered. Structural neuroimaging studies, as well as comprehensive vascular imaging of head and neck, are necessary to exclude secondary causes. The diagnosis of primary exertional headache and primary sexual headache should be based on the criteria proposed in the International Classification of Headache Disorders, 3rd edition (beta version). Impaired cerebral autoregulation or venous stenosis has been proposed as possible pathophysiology. Beta blocker and indomethacin might be effective treatment, but large-scale randomized placebo-controlled studies are required to provide solid evidence.

Headache as anUnusual Presentation of Ischemic Heart Disease: A Case Report

The clinical features of coronary artery disease vary, and patients may present with symptoms other than chest pain, such as headache. Rarely, the headache may be theonly presenting feature without any chest discomfort, and may be confused with migraine. Failure to distinguish such headache, caused by CAD, from migraine may result in wrong treatment with disastrous fate. Elderly patient with the presence of cardiovascular risk factors having recent onset exertional headache should be evaluated for the presence of cardiac cephalgia.We intend to report a 60-year-old hypertensive, diabetic patient with a 6-months history of episodic exertional headaches, who turned out to be a case of headache angina (cardiac cephalgia). Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 81-86

Cardiac cephalalgia: severe, non-exertional headache presenting as unstable angina

Cardiac cephalalgia is a migraine-like headache that occurs during episodes of myocardial ischaemia. Clinical characteristics of the headache vary widely but are often severe in intensity, worsen with reduced myocardial perfusion and resolve with reperfusion. It can present along with typical symptoms of angina pectoris, although not always. We present a 64-year-old man with a 6-month history of severe, non-exertional headaches occurring with increasing frequency. A resting ECG showed ST elevation in the inferior leads. His serum troponin I was not elevated. Coronary angiography showed severe stenosis of his right coronary artery, which was successfully stented by percutaneous coronary intervention. He remains headache free at 2-year follow-up.