a Cardiac cephalalgia attacks provoked by Prinzmetal angina - a case report

A 51-year-old man with no past medical history of headache or risk factors for vascular diseases was diagnosed with supraventricular tachycardia (SVT) in 2005. In 2014 SVT attacks were longer and always followed by severe headache attacks. Accompanying symptoms were dizziness, non-rotational vertigo, confusion, episodes of double vision and tinnitus; these symptoms would last one day, followed by severe tiredness for 2 days. Neurologic and cardiologic evaluation as well as extensive diagnostic test between the attacks was normal. Catheter coronarography showed no stenoses but did show spasms in distal left anterior descending artery. A remarkable effect on SVT and headaches was shown after the introducement of diltiazem. The diagnosis cardiac cephalalgia (CC) was established. As our case report is unique, we hope that our observations will help cardiologists and neurologists to better understand and treat patients with CC. CC should be distinguished from migraine, to avoid prescribing triptans and vasoconstrictors.

CARDIAC CEPHALALGIA

Cardiac cephalalgia merupakan nyeri kepala seperti migraine, umumnya namun tidak selalu diperberat dengan aktivitas fisik, timbul selama peristiwa myocardial ischaemia, membaik dengan pemberian nitroglycerine. Cardiac cephalalgia merupakan kasus nyeri kepala yang jarang namun dapat mempengaruhi aspek biopsikososial dan kualitas hidup penderita. Berdasarkan The Internasional Classification of Headache Disorder (ICHD), cardiac cephalalgia digolongkan ke dalam nyeri kepala sekunder yang terkait dengan kelainan homeostasis. Artikel ini membahas pengetahuan terbaru mengenai cardiac cephalalgia terkait definisi, epidemiologi, patofisiologi, gambaran klinis, penegakan diagnosis, diagnosis banding, serta pilihan terapinya dengan melakukan pencarian, review dan telaah serta menyimpulkan berbagai literatur terbaru terkait hal tersebut. Cardiac cephalalgia sering ditemukan pada usia dekade lima. Penegakkan diagnosis berdasarkan nyeri kepala yang berkaiatan dengan adanya myocardial ischaemia, dan berespon baik dengan pemberian nitroglycerine. Penatalaksanaan cardiac cephalalgia menitikberatkan pada penanganan myocardial ischaemia. Nitroglycerine merupakan pilihan utama untuk nyeri kepala Kata Kunci : Cardiac Cephalalgia, Nyeri Kepala Sekunder, Myocardial Ischaemia

Headache associated with systemic infection, intoxication, or metabolic derangement

This chapter discusses headaches attributed to exposure to a substance, disorders of homeostasis, high altitude, airplane travel, diving, sleep apnoea, dialysis, cardiac cephalalgia, hypertension, metabolic derangement, and systemic infection.

Some rare headache disorders, including Alice in Wonderland syndrome, blip syndrome, cardiac cephalalgia, epicrania fugax, exploding head syndrome, Harlequin syndrome, lacrimal neuralgia, neck–tongue syndrome, and red ear syndrome

A fascinating array of rare headache disorders—Alice in Wonderland syndrome, blip syndrome, cardiac cephalalgia, epicrania fugax, exploding head syndrome, harlequin syndrome, lacrimal headache, ictal epileptic headache, neck–tongue syndrome, and red ear syndrome—are reviewed in this chapter. Appropriate diagnosis and treatment as appropriate can be most reassuring to the patient. There are additional rare headache disorders just waiting to be described by astute clinicians.

Cardiac cephalalgia: A deadly case report

Cardiac cephalalgia is a nosologic entity that has only been acknowledged by the turn of the century, and is, consequently, often underdiagnosed, even by experienced neurologists. Unlike most headaches, however, failing to provide a proper and timely diagnosis can have deadly consequences. Report of a case of cardiac headache attended at the emergency department and literature review. This entity was first described in 1997; no studies have yet determined its prevalence, with the literature relying on case reports. The pathophysiology remains a mystery, with three main hypothesis: spinal convergence of cardiac visceral afferent nerves with somatic afferent nerves from the head, increase of intracranial pressure from decrease in cerebral venous return originated from the reduced cardiac output, and release of inflammatory markers during cardiac ischaemia, such as bradykinin, serotonin and histamin, causing vascular changes. Distinguishing this pathology from others, especially migraine, with which it shares many traits, is of paramount importance: vasoconstrictor drugs such as triptans are absolutely contraindicated, and the outcome can be dramatic. This case illustrates the need to promptly recognize this rare entity since failure to diagnose it can have devastating consequences.

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.