Kobata Hitoshi
Osaka Mishima Emergency Critical Care Center, 11-1 Minamiakutagawa-cho Takatsuki, Osaka, 569-1124, Japan.
Int J Emerg Med. 2022 Jul 29;15(1):33. doi: 10.1186/s12245-022-00436-2.
Cardiac damage is common in patients with acute brain injury; however, little is known regarding cardiac-induced neurological symptoms. In the International Classification of Headache, Third Edition (ICHD-III), cardiac cephalalgia is classified as a headache caused by impaired homeostasis.
This report presents four patients with acute myocardial infarction (AMI) who presented with headache that fulfilled the ICHD-III diagnostic criteria for cardiac cephalalgia. A systematic review of cardiac cephalalgia using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines is also presented.
Case 1: A 69-year-old man with a history of percutaneous coronary intervention (PCI) developed sudden severe occipital pain, nausea, and cold sweating. Coronary angiography (CAG) revealed occlusion of the right coronary artery (RCA). Case 2: A 66-year-old woman complained of increasing occipitalgia and chest discomfort while riding a bicycle. CAG demonstrated 99% stenosis of the left anterior descending artery. Case 3: A 54-year-old man presented with faintness, cold sweating, and occipitalgia after eating lunch. CAG detected occlusion of the RCA. Case 4: A 72-year-old man went into shock after complaining of a sudden severe headache and nausea. Vasopressors were initiated and emergency CAG was performed, which detected three-vessel disease. In all four, electrocardiography (ECG) showed ST segment elevation or depression and echocardiography revealed a left ventricular wall motion abnormality. All patients underwent PCI, which resulted in headache resolution after successful coronary reperfusion. A total of 59 cases of cardiac cephalalgia were reviewed, including the four reported here. Although the typical manifestation of cardiac cephalalgia is migraine-like pain on exertion, it may present with thunderclap headache without a trigger or chest symptoms, mimicking subarachnoid hemorrhage. ECG may not always show an abnormality. Headaches resolve after successful coronary reperfusion.
Cardiac cephalalgia resulting from AMI can present with or without chest discomfort and even mimic the classic thunderclap headache associated with SAH. It should be recognized as a neurological emergency and treated without delay.
心脏损伤在急性脑损伤患者中很常见；然而，关于心脏引起的神经症状却知之甚少。在《国际头痛分类第三版》（ICHD-III）中，心脏性头痛被归类为由内环境稳态受损引起的头痛。
本报告介绍了4例急性心肌梗死（AMI）患者，他们出现了符合ICHD-III心脏性头痛诊断标准的头痛症状。还使用系统评价和Meta分析的首选报告项目指南对心脏性头痛进行了系统评价。
病例1：一名有经皮冠状动脉介入治疗（PCI）病史的69岁男性，突然出现严重的枕部疼痛、恶心和冷汗。冠状动脉造影（CAG）显示右冠状动脉（RCA）闭塞。病例2：一名66岁女性在骑自行车时抱怨枕部疼痛加剧和胸部不适。CAG显示左前降支动脉99%狭窄。病例3：一名54岁男性午餐后出现头晕、冷汗和枕部疼痛。CAG检测到RCA闭塞。病例4：一名72岁男性在抱怨突然出现严重头痛和恶心后陷入休克。开始使用血管升压药并进行了急诊CAG，检测到三支血管病变。在所有4例患者中，心电图（ECG）显示ST段抬高或压低，超声心动图显示左心室壁运动异常。所有患者均接受了PCI治疗，冠状动脉再灌注成功后头痛缓解。共回顾了59例心脏性头痛病例，包括本文报告的4例。虽然心脏性头痛的典型表现是劳力性偏头痛样疼痛，但也可能表现为无诱因的霹雳样头痛或胸部症状，类似蛛网膜下腔出血。ECG不一定总是显示异常。冠状动脉再灌注成功后头痛缓解。
AMI导致的心脏性头痛可能伴有或不伴有胸部不适，甚至可模仿与SAH相关的典型霹雳样头痛。应将其视为神经急症并立即治疗。
