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Cardiac cephalalgia: severe, non-exertional headache presenting as unstable angina
  1. Jonathan Lazari1,
  2. Andrew Money-Kyrle1,
  3. Benjamin R Wakerley2,3
  1. 1 Department of Cardiology, Buckinghamshire Healthcare NHS Trust, Amersham, UK
  2. 2 Department of Neurology, Gloucestershire Royal Hospital, Gloucester, UK
  3. 3 Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
  1. Correspondence to Dr Jonathan Lazari, Cardiology, Buckinghamshire Healthcare NHS Trust, HP11 2TT, UK; j.lazari{at}


Cardiac cephalalgia is a migraine-like headache that occurs during episodes of myocardial ischaemia. Clinical characteristics of the headache vary widely but are often severe in intensity, worsen with reduced myocardial perfusion and resolve with reperfusion. It can present along with typical symptoms of angina pectoris, although not always. We present a 64-year-old man with a 6-month history of severe, non-exertional headaches occurring with increasing frequency. A resting ECG showed ST elevation in the inferior leads. His serum troponin I was not elevated. Coronary angiography showed severe stenosis of his right coronary artery, which was successfully stented by percutaneous coronary intervention. He remains headache free at 2-year follow-up.

  • cardiac cephalalgia
  • acute coronary syndrome
  • unstable angina

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  • Contributors JL, AM-K: acquired data and drafted the manuscript. BRW: supervised and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed. Externally peer reviewed by Richard Stark, Melbourne, Australia.

  • Data sharing statement Yes - we are happy to share data for this case.

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