Cardiac Cephalgia: Angina in the Head

Cardiac cephalgia is a migraine like headache that occurs during episodes of myocardial ischaemia. Although most of the patients presenting with ischaemic heart disease have chest pain, there are other rare presenting symptoms like cardiac cephalgia. Headache can be the only presentation of coronary artery disease. We report a case of a 57 years-old man, Presenting with only headache during brisk walking, Exercise Tolerance Test (ETT) was positive for Electrocardiograph (ECG) evidence of provocable myocardial ischemia, who latter was diagnosed as double vessel coronary artery diseaseon Coronary Angiogram (CAG). As the patient preferred remaining without revascularization, he was put onto optimum medical management for ischaemic heart disease. A follow up visit after one month revealed, marked improvement of the headache with anti anginal medications. Early evaluation and diagnosis of the headache symptom should be done because treatment with anti-migraine drugs may deteriorate headache and undermine the diagnosis of coronary artery disease. Bangladesh Med J. 2019 Sep; 48 (3): 46-49

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