Cardiac cephalgia: A headache of the heart

Headache: The Journal of Head and Face Pain, 2013

Objective/Background.-Some headache syndromes have few cases reported in the literature. Their clinical characteristics, pathogenesis, and treatment may have not been completely defined. They may not actually be uncommon but rather underrecognized and/or underreported. Methods.-A literature review of unusual headache syndromes, searching PubMed and ISI Web of Knowledge, was performed. After deciding which disorders to study, relevant publications in scientific journals, including original articles, reviews, meeting abstracts, and letters or correspondences to the editors were searched. Findings.-This paper reviewed the clinical characteristics, the pathogenesis, the diagnosis, and the treatment of five interesting and unusual headache syndromes: exploding head syndrome, red ear syndrome, neck-tongue syndrome, nummular headache, and cardiac cephalgia. Conclusions.-Recognizing some unusual headaches, either primary or secondary, may be a challenge for many nonheadache specialist physicians. It is important to study them because the correct diagnosis may result in specific treatments that may improve the quality of life of these patients, and this can even be life saving.

The Journal of Headache and Pain, 2018

Background: Headache is a common feature in acute cerebrovascular disease but no studies have evaluated the prevalence of specific headache types in patients with transient ischemic attacks (TIA). The purpose of the present study was to analyze all headaches within the last year and the last week before TIA and at the time of TIA. Methods: Eligible patients with TIA (n = 120, mean age 56.1, females 55%) had focal brain or retinal ischemia with resolution of symptoms within 24 h without presence of new infarction on MRI with DWI (n = 112) or CT (n = 8). All patients were evaluated within one day of admission by a single neurologist. As a control group we used patients (n = 192, mean age 58.7, females 64%) admitted with diagnoses "lumbago", "lumbar spine osteochondrosis" or "gastrointestinal ulcer". Results: One-year prevalence of migraine without aura was significantly higher in TIA patients than in controls: 20.8% and 7.8% respectively (p = 0.002, OR 3.1, 95% CI 1.6-6.2). 22 patients (18.3%) had sentinel or warning headache within the last week before TIA. At the time of TIA a new type of headache was observed in 16 patients (13.3%). No controls had a new type of headache. 12 of these 16 patients had migraine-like headache, 8 patients had tension-type-like headache and one patient thunderclap headache. Posterior circulation TIA was associated with headaches within last week before TIA and at the time of TIA much more frequently than anterior circulation TIA. Conclusions: The one year prevalence of migraine was significantly higher in TIA patients than in controls and so was the prevalence of headache within the last week before TIA and at the time of TIA. A previous headache that worsens and a new type of headache can be a warning of impending TIA.

The Journal of Headache and Pain, 2001

Neurology, 2006

To investigate the clinical pictures of patients with recurrent thunderclap headaches of unknown etiology and to field-test two relevant International Classification of Headache Disorders, 2nd edition (ICHD-II) criteria, i.e., primary thunderclap headache (Code 4.6) and benign (or reversible) angiopathy of the CNS (Code 6.7.3). Methods: We prospectively recruited patients presenting with idiopathic recurrent thunderclap headaches from a hospital-based headache clinic. Detailed histories, neurologic examinations, and MRIs and magnetic resonance angiographies (MRAs) were performed in all patients to exclude secondary causes. Patients with cerebral vasoconstriction received serial MRA follow-up. Results: Fifty-six consecutive patients (51 female/5 male, mean age 49.6 Ϯ 9.8 [range 22 to 76] years) were enrolled. Segmental vasoconstriction (or benign CNS angiopathy) was found in 22 patients (39%). Thunderclap headache recurred in all patients with a median frequency of 0.7 times per day for a median period of 14 days (range 6 to 86 days). The median duration for each single attack was 3 hours. Most patients (84%) reported at least one trigger. Nimodipine effectively aborted further attacks in 83% of the treated patients. Headache attacks subsided within 3 months. Four patients (7%) developed ischemic complications. Patients with and without vasoconstriction based on MRA images were similar regarding demographics and headache profile. Except for the duration criterion, our patients generally mapped well into the proposed ICHD-II criteria. Conclusions: This study suggests that the two diagnostic entities proposed by the ICHD-II may present different spectra of the same disorder. The distinct headache profile may help physicians quickly recognize this disabling headache disorder with risk of stroke and provide timely treatment.

Seminars in Pediatric Neurology, 1995

When a headache develops in a child or adolescent, both the patient and the parents may fear the presence of a brain tumor. However, most headaches are not a symptom of a serious neurological disease but are related to stress or migraine. In this article, headaches in relationship to neurological disorders are reviewed. The pathophysiology of head pain and Increased Intracranlal pressure are reviewed. Methods used to evaluate patients suspected of harboring an intracranial abnormality include a thorough history, a carefully performed physical examination, and neuroimaging studies. This article reviews cerebrovascular disease, neoplasms, hydrocephalus, and other structural abnormalities that cause headaches.

Handbook of clinical neurology, 2010

Headache with variable characteristics and associated signs and symptoms may occur in all forms of arteritis. Giant cell arteritis, one of the most common forms, involves branches of the external and, more rarely, of the internal carotid arteries. It occurs in patients over the age of 50 and is characterized by fever, new-onset headache, prominence and tenderness of the temporal artery, claudication of the masticatory muscles on chewing, amaurosis fugax, and visual loss. Headache is the initial symptom in 48% of patients and is present in 90%. Primary central nervous system angiitis is a rare and highly fatal disease in which headache is one of the most frequent symptoms despite the fact that, given its non-specific characteristics, it is of little diagnostic relevance. Headache may also be attributed to several secondary central nervous system arteritides such as Behçet's disease, Takayasu disease, polyarteritis nodosa, Kawasaki disease, Wegener's granulomatosis, systemic l...

Current Pain and Headache Reports, 2013

Cranial or cervical vascular disease is commonly associated with headaches. The descriptions may range from a thunderclap onset of a subarachnoid hemorrhage to a phenotype similar to tension type headache. Occasionally, this may be the sole manifestation of a potentially serious underlying disorder like vasculitis. A high index of clinical suspicion is necessary to diagnose the disorder. Prompt recognition and treatment is usually needed for many conditions to avoid permanent sequelae that result in disability. Treatments for many conditions remain challenging and are frequently controversial due to paucity of well controlled studies. This is a review of the recent advances that have been made in the diagnosis or management of these secondary headaches.

Headache: The Journal of Head and Face Pain, 1975

Thirty-four patients with transient ischemic attacks (TIA) have been followed for 1 to 24 months. Twenty-two patients had TIA in the anterior and 12 in the posterior circulation. Episodic and late onset vascular headaches occurred. Four patients had episodic headaches, 7 patients had late onset vascular headaches and 11 patients had both types of headaches. Episodic headaches preceded, occurred during, or immediately after TIA. These headaches were present in 15 of the patients (44%). Late onset vascular headaches started in middle or late life, occurred independently of TIA and were observed in 18 patients (52.9%). In 13 patients the headaches began 1 month to 15 years prior to TIA and in 5 cases, 2 days to 1 year after the onset of TIA. Late onset vascular headaches preceded TIA in 38.2% of patients. These headaches might be of prognostic significance in some patients for the development of TIA and stroke.

Stroke, 1990

Although a number of reports are available on the occurrence of headache in patients with ischemic cerebrovascular disease, most studies have recorded the frequency bat not the specific sites of the pain. We report 18 patients who underwent balloon inflation in the distal internal carotid artery and middle cerebral artery stem during embolization therapy for intracerebral arteriovenous malformations. Eleven patients had reproducible patterns of headache during balloon inflation. Inflation in the proximal middle cerebral artery stem produced pain primarily in the ipsilateral temple, that in the middle of the middle cerebral artery stem produced pain referred primarily retro-orbitally, and inflation in the distal middle cerebral artery stem produced pain referred primarily to the forehead. Experimental studies have demonstrated similar patterns of referred pain. The fact that these areas of referred pain are so reproducible is of potentially great clinical importance in the approach to management of patients with cerebrovascular disease. (Stroke 1990;21:555-559) A lthough a number of reports are available on / \ the occurrence of headache in patients with X \ . ischemic cerebrovascular disease, most studies have recorded the frequency but not the specific sites of the pain. 1 -7 Some authors have noted that carotid-distribution headaches tend to be located anteriorly and that vertebrobasilar-associated headaches tend to be located posteriorly. The fact that in most studies of cerebrovascular disease only a minority of patients are reported to develop headache has lead some clinicians to dismiss its importance. Unfortunately, from the reports of headache in patients with cerebrovascular disease it has not been possible to determine precisely the site, and frequently the type, of arterial disease. In part, this has resulted from an inability to define precisely the location of the arterial injury. In addition, it is frequently difficult to obtain an accurate history from patients who are acutely ill and/or neurologically impaired. Thus, the potential utility of localized head pain associated with focal

Headache: The Journal of Head and Face Pain, 2009