Andadola Udayanga, Poornima Subhani, Galappatthy Gamini
Department of Primary Care and Family Medicine, Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Ratnapura, Sri Lanka.
Cardiology Unit, The National Hospital of Sri Lanka, Colombo, Sri Lanka.
BMC Cardiovasc Disord. 2025 Jun 7;25(1):435. doi: 10.1186/s12872-025-04898-z.
Ischaemic heart disease commonly presents with chest pain and autonomic symptoms; however, atypical manifestations can occur. Cardiac cephalalgia is a rare presentation of acute coronary syndrome, characterised by a migraine-like headache triggered by myocardial ischaemia. Diagnosis requires a high index of suspicion.
We describe a 47-year-old man with diabetes and a history of smoking who presented with an acute, severe frontotemporal headache accompanied by nausea and vomiting. Electrocardiography revealed ST-segment elevation in the inferior leads. Coronary angiography demonstrated multivessel coronary artery disease involving the right coronary artery and the left anterior descending artery. A subsequent measurement of serum troponin I confirmed myocardial injury. Both arteries were successfully stented, leading to clinical improvement and resolution of the headache.
This case highlights the importance of considering cardiac causes in patients presenting with severe headaches particularly in those with cardiovascular risk factors.
缺血性心脏病通常表现为胸痛和自主神经症状；然而，也可能出现非典型表现。心脏性头痛是急性冠状动脉综合征的一种罕见表现，其特征为由心肌缺血引发的类似偏头痛的头痛。诊断需要高度的怀疑指数。
我们描述了一名47岁患有糖尿病且有吸烟史的男性，他出现急性、严重的额颞部头痛，并伴有恶心和呕吐。心电图显示下壁导联ST段抬高。冠状动脉造影显示多支冠状动脉病变，累及右冠状动脉和左前降支动脉。随后测定血清肌钙蛋白I证实存在心肌损伤。两条动脉均成功置入支架，头痛症状临床改善并消失。
该病例强调了对于出现严重头痛的患者，尤其是有心血管危险因素的患者，考虑心脏病因的重要性。
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