Man Yu-Hong, Meng Xiao-Li, Yu Ting-Min, Yao Gang
Department of Neurology, The Second Hospital of Jilin University, Changchun, China.
Medicine (Baltimore). 2018 Dec;97(50):e13629. doi: 10.1097/MD.0000000000013629.
Co-occurrence of headache and arrhythmia is not rare. However, their causal relationship remains unclear. Here, we described a case of migraine-like headache relieving with pacemaker implantation. Our case study indicates that arrhythmia is causal for migraine-like headache, which, to our knowledge, has never been reported.
A 63-year-old woman patient suffered from paroxysmal headache with a visual aura presenting like migraine for 2 years. No ophthalmic or neurological disorder was found, but cardiac examination detected bradycardia, which was confirmed by 24-hour dynamic electrocardiogram (DCG) revealing sinus bradycardia mixed with ventricular premature beats and supraventricular tachycardia. Transcranial doppler (TCD) detected an equal echo flat plaque on the anterolateral wall of the common carotid artery (CA) bifurcation.
Migraine-like headaches secondary to arrhythmia.
The patient underwent pacemaker implantation.
Both visual aura and headache were resolved following pacemaker implantation.
To the best of the authors' knowledge, we are the first to report migraine-like headache as a secondary symptom of arrhythmia. Arrhythmia may aggravate insufficient blood supply to the brain due to CA lesion and induce a migraine-like headache. This case study indicated that pacemaker implantation could be a fundamental treatment for migraine-like headaches caused by cardiac arrhythmia.
头痛和心律失常同时出现并不罕见。然而，它们之间的因果关系仍不明确。在此，我们描述了一例通过起搏器植入缓解偏头痛样头痛的病例。我们的病例研究表明，心律失常是偏头痛样头痛的病因，据我们所知，此前从未有过相关报道。
一名63岁女性患者，阵发性头痛伴视觉先兆，类似偏头痛症状已持续2年。未发现眼科或神经系统疾病，但心脏检查发现心动过缓，24小时动态心电图（DCG）证实为窦性心动过缓合并室性早搏和室上性心动过速。经颅多普勒（TCD）检测发现颈总动脉（CA）分叉前外侧壁有等回声扁平斑块。
心律失常继发的偏头痛样头痛。
患者接受了起搏器植入手术。
起搏器植入后，视觉先兆和头痛均得到缓解。
据作者所知，我们首次报道偏头痛样头痛作为心律失常的继发症状。心律失常可能因CA病变加重脑部供血不足，诱发偏头痛样头痛。本病例研究表明，起搏器植入可能是治疗心律失常所致偏头痛样头痛的根本方法。
