These heart conditions are serious as up to 12% of people died of the heart disease that had caused their headache condition.
The headache of heart disease is usually dull, one sided, and experienced in the face, eye or forehead. It can even be felt in the back of the head (about 20% in one series were occipital headache).
There has been a recent case of Thunderclap Headache caused by an acute heart attack.
Like angina, heart-disease headaches are brought on by exercising, including the exertion associated with sexual activity.
The most comprehensive review of cardiac cephalalgia by Drs Wie and Wang 2008 reviewed 34 cases.
It is interesting to note that 11/34 cases had eye pain as a manifestation of their cardiac condition. This may be a clinical pointer – consider heart disease in exertional unilateral eye pain. Cardiac pain can also present as isolated ear pain.
Headache has been noted in up to 6% of angina sufferers (out of a series of nearly 200 people), yet none had pure headache.
This means that heart disease should not be the first consideration in diagnosis of headache. However, as fatal cases are recorded, the diagnosis is something anyone treating severe headaches should know.
An older person with cardiovascular risk factors who presents with thunderclap headache or exercise headache would be the sort of person I’d have in mind.
My own experience of cardiac cephalalgia was an older man presenting to hospital with occipital headache and breathlessness, who subsequently was diagnosed as non-ST elevation MI and congestive cardiac failure. Another gentleman, in his 70s, developed headaches on exercise which were related to angina.
What diagnostic tests should I perform?
If you think of this diagnosis, then – usually a treadmill test is necessary to try and establish a diagnosis. Descriptions of further cardiac investigations are beyond my area of expertise.
Any exercise induced headache should also have brain imaging, usually a CT Brain is sufficient.
However, if the headache was thunderclap, then a Lumbar Puncture should be performed.
Why is heart pain felt in the head?
The explanation usually given for heart disease being sensed in the head is the phenomenon of “neural convergence”.
The vagus nerve is the main nerve from the heart which transmits angina pain to the brain. In the upper part of the spinal cord, fibres from the vagus nerve converge (or mix) with fibres from the trigeminal nerve.
The trigeminal nerve is that main sensory nerve of the head and face. It is through activation of the trigeminal nerve from these connecting vagus nerve fibres that heart attack pain or angina pain becomes a heart disease headache or cardiac cephalalgia.
Most people who suffer headaches will not have cardiac cephalalgia. If you do not have a dangerous cause for your headaches you should read my guide to self-care called ‘The Billionaire’s Book of Headaches’.