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Cardiac cephalalgia: case reports and review


  • J-H Wei,

    Corresponding author
    1. Divisions of Cardiology and
    2. Institute of Clinical Medicine, National Yang-Ming University, Taipei, and
    3. Department of Cardiovascular Medicine, Min-sheng General Hospital, Taoyuan, Taiwan
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  • H-F Wang

    1. Neurology, Department of Medicine, Tungs' Taichung Metro Harbor Hospital, WuChi, Taichung,
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Jih-Hua Wei, MD, 7F, No. 13, Lane 18, Sec. 1, Hangzhou S. Road, Zhongzheng District, Taipei City 100, Taiwan. E-mail


Diagnosis of myocardial infarction or acute coronary syndrome is difficult, especially in atypical presentation at an emergency department, and sometimes results in serious legal issues. Symptoms of atypical presentation include shortness of breath, dyspnoea on exertion, toothache, abdominal pain, back pain and throat pain. As of now, reports of a headache, especially exertional headache, as the only presentation of acute cardiac ischaemia are rare and only have case reports. We present two patients with a cardiac source of headache and analyse 32 patients with similar situations from MEDLINE search from 1966 to the present. Cardiac cephalalgia is benign in general, but potential risks for death should be considered. If the patient has increased risk of atherosclerosis with exertional headache, anginal headache should be highly suspected and further work-up should be undertaken.