Severe explosive headache: a sole presentation of acute myocardial infarction in a young man

ArticleinAmerican Journal of Emergency Medicine 25(2):250-1 · March 2007with6 Reads
DOI: 10.1016/j.ajem.2006.11.014 · Source: PubMed
    • "The frequency of this headache is highly variable and is concomitant with the acute cardiovascular event. Fifty-seven percent of patients show ECG abnormalities at rest [4] as well as elevated cardiac enzymes [5], and in the remaining ECG changes appear only during stress [6]. It is not surprising CC does not respond to simple painkill- ers [7], but promptly responds to nitrates. "
    [Show abstract] [Hide abstract] ABSTRACT: Although most of the patients presenting with ischemic heart disease have chest pains, there are other rare presenting symptoms like car-diac cephalgia. In this report, we present a case of acute coronary syndrome with an only presentation of exertional headache. It was postulated as acute presentation of coronary artery disease, due to previous history of similar presentation associated with some chest pains with previous left coronary artery stenting. We present an unu-sual case with cardiac cephalgia in a young patient under the age of 50 which was not reported at that age before. There are four suggested mechanisms for this cardiac presentation.
    Full-text · Article · Dec 2014 · The Journal of Headache and Pain
    • "An example of this is Headache Associated with Sexual Activity where a recent case series from Taiwan has identified the Reversible Cerebral Vasoconstriction Syndrome in almost 2/3rds of cases [278]. By their nature, case reports will focus on the esoteric or unusual, but our review has highlighted some important associations including systemic conditions like Aortic Dissection [233,234,279,280], Cardiac Cephalalgia [26,227228229231,232,281282283, Phaeochromocytoma [236,237], serious infections like Dengue Haemorrhagic Fever [74] and Q-Fever [72], as well as Erve Virus [68,71] . Rare vasculopathies such as Vogt-Kayanagi-Harada Disease [121,122], or cerebral vasculitis [119] do appear on the differential diagnosis. "
    [Show abstract] [Hide abstract] ABSTRACT: There are many potential causes of sudden and severe headache (thunderclap headache), the most important of which is aneurysmal subarachnoid haemorrhage. Published academic reviews report a wide range of causes. We sought to create a definitive list of causes, other than aneurysmal subarachnoid haemorrhage, using a systematic review. Systematic Review of EMBASE and MEDLINE databases using pre-defined search criteria up to September 2009. We extracted data from any original research paper or case report describing a case of someone presenting with a sudden and severe headache, and summarized the published causes. Our search identified over 21,000 titles, of which 1224 articles were scrutinized in full. 213 articles described 2345 people with sudden and severe headache, and we identified 6 English language academic review articles. A total of 119 causes were identified, of which 46 (38%) were not mentioned in published academic review articles. Using capture-recapture analysis, we estimate that our search was 98% complete. There is only one population-based estimate of the incidence of sudden and severe headache at 43 cases per 100,000. In cohort studies, the most common causes identified were primary headaches or headaches of uncertain cause. Vasoconstriction syndromes are commonly mentioned in case reports or case series. The most common cause not mentioned in academic reviews was pneumocephalus. 70 non-English language articles were identified but these did not contain additional causes. There are over 100 different published causes of sudden and severe headache, other than aneurysmal subarachnoid haemorrhage. We have now made a definitive list of causes for future reference which we intend to maintain. There is a need for an up to date population based description of cause of sudden and severe headache as the modern epidemiology of thunderclap headache may require updating in the light of research on cerebral vasoconstriction syndromes.
    Full-text · Article · Aug 2014
    • "Cases have been reported (33%) in which the headache appeared at rest. The frequency of this headache is highly variable; it may appear only in concomitance with the acute cardiovascular event [10, 11,151617181920 or may be more frequent and even occur daily [4, 5, 9, 21] for periods lasting from a few weeks [5, 9, 12, 13, 22–25] to several years [6, 8, 14, 21, 26, 27]. Fifty-seven per cent of patients shows pathological alterations of the baseline ECG trace, such as ST-segment elevations or depressions and T-wave inversions [5, 8–11, 13, 15–20, 25, 27–29], as well as elevated cardiac enzymes [5, 7, 10, 11, 16–20, 26, 27]. "
    [Show abstract] [Hide abstract] ABSTRACT: The purpose of this review was to provide a critical evaluation of medical literature on so-called "cardiac cephalgia" or "cardiac cephalalgia". The 2004 International Classification of Headache Disorders codes cardiac cephalgia to 10.6 in the group of secondary headaches attributed to disorder of homoeostasis. This headache is hardly recognizable and is associated to an ischaemic cardiovascular event, of which it may be the only manifestation in 27% of cases. It usually occurs after exertion. Sometimes routine examinations, cardiac enzymes, ECG and even exercise stress test prove negative. In such cases, only a coronary angiogram can provide sufficient evidence for diagnosis. Cardiac cephalgia manifests itself without a specific pattern of clinical features: indeed, in this headache subtype there is a high variability of clinical manifestations between different patients and also within the same patient. It "mimics" sometimes a form of migraine either accompanied or not by autonomic symptoms, sometimes a form of tension-type headache; on other occasions, it exhibits characteristics that can hardly be interpreted as typical of primary headache. Pain location is highly variable. When the headache occurs as the only manifestation of an acute coronary event, the clues for suspicion are a) older age at onset, b) no past medical history of headache, c) presence of risk factors for vascular disorders and d) onset of headache under stress. Knowledge of cardiac cephalgia is scarce, due to its rare clinical occurrence and to the scant importance given to headache as a symptom concomitantly with an ischaemic cardiac event.
    Full-text · Article · Feb 2009
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