Myocardial ischemia could cause headaches. The International Classification of Headache Disorders-III classifies cardiac cephalalgia as one of the headaches caused by impaired homeostasis. Migraine-like headache occurring on exertion is the typical manifestation, whereas thunderclap headache might rarely develop.
A 72-year-old man was brought to the emergency room with complaints of severe headache and vomiting. His Glasgow Coma Scale was 12 (E3, V4, M5), and head CT scans and CT angiogram following the initial resuscitation revealed no abnormality. An electrocardiogram demonstrated ST-segment depression, and an echocardiogram showed postero-leteral wall akinesis. He went into shock status during the procedure, and an emergency coronary angiogram showed three-vessel disease. Percutaneous coronary intervention was conducted for the right coronary artery, and the patient was transferred for further treatment. Recognition of cardiac cephalalgia and timely treatment for culprit lesions should be emphasized.
