Antoun Ibrahim, Helal Ayman, Wassef Nancy, Farooq Mohsin
Department of Cardiology, Kettering General Hospital, Kettering, UK.
Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
Catheter Cardiovasc Interv. 2025 Jun;105(7):1726-1729. doi: 10.1002/ccd.31521. Epub 2025 Mar 28.
Headache is a rare yet clinically significant presentation of ischaemic heart disease (IHD). While chest pain is the hallmark symptom of myocardial ischaemia (MI), some patients present with atypical symptoms, such as headaches, which lead to diagnostic challenges and potential delays in treatment. This case series highlights the diagnostic complexity and clinical significance of headache-predominant presentations of both acute and chronic coronary syndromes, emphasizing the need for a comprehensive differential diagnosis in patients with cardiovascular risk factors. We present two cases where headache was the primary symptom of MI. The first case describes an acute ischaemic event wherein the headache preceded the onset of classic cardiac symptoms, leading to the identification of an occluded obtuse marginal artery. This was the second case in our institution where a previous patient presented with exertion-induced headaches, ultimately diagnosed as a chronic total occlusion of the left anterior descending (LAD) artery, which was successfully revascularised. Two years later, the same patient re-presented with acute coronary syndrome secondary to disease in a different coronary artery and his presentation was solely with headache. Both cases were successfully managed with percutaneous revascularisation, resulting in the resolution of symptoms and reinforcing the link between headache and CAD. These cases underscore the importance of considering ACS and chronic stable angina in patients presenting with unexplained headaches, particularly when symptoms are exertional or pressure-like. Early cardiac assessment, including ECG and further imaging when indicated, is essential for timely intervention. Raising the awareness of exertional headache as a potential ischaemic symptom may facilitate earlier diagnosis and prevent adverse outcomes. Further research is required to elucidate the mechanisms underlying headaches in MI and refine diagnostic approaches for atypical cardiac presentations.
头痛是缺血性心脏病（IHD）一种罕见但具有临床意义的表现。虽然胸痛是心肌缺血（MI）的典型症状，但一些患者会出现非典型症状，如头痛，这会带来诊断挑战并可能导致治疗延误。本病例系列突出了以头痛为主的急性和慢性冠状动脉综合征表现的诊断复杂性及临床意义，强调了对有心血管危险因素患者进行全面鉴别诊断的必要性。我们呈现两例以头痛为心肌梗死主要症状的病例。第一例描述了一次急性缺血事件，其中头痛先于典型心脏症状出现，最终发现是钝缘支动脉闭塞。这是我们机构的第二例此类病例，前一例患者表现为劳力性头痛，最终诊断为左前降支（LAD）动脉慢性完全闭塞，该患者成功进行了血管再通。两年后，同一患者因不同冠状动脉疾病再次出现急性冠状动脉综合征，其表现仅为头痛。两例均通过经皮血管再通成功治疗，症状得以缓解，强化了头痛与冠心病之间的联系。这些病例强调了对于出现不明原因头痛的患者，尤其是症状为劳力性或类似压榨性时，考虑急性冠状动脉综合征（ACS）和慢性稳定型心绞痛的重要性。早期心脏评估，包括心电图检查以及必要时的进一步影像学检查，对于及时干预至关重要。提高对劳力性头痛作为潜在缺血症状的认识可能有助于早期诊断并预防不良后果。需要进一步研究以阐明心肌梗死中头痛的潜在机制，并完善非典型心脏表现的诊断方法。
