PT  - JOURNAL ARTICLE
AU  - Costopoulos, C
TI  - Acute coronary syndromes can be a headache
AID  - 10.1136/emj.2009.082271
DP  - 2011 Jan 01
TA  - Emergency Medicine Journal
PG  - 71--73
VI  - 28
IP  - 1
4099  - http://emj.bmj.com/content/28/1/71.short
4100  - http://emj.bmj.com/content/28/1/71.full
SO  - Emerg Med J2011 Jan 01; 28
AB  - Ischaemic heart disease is a common cause of morbidity and mortality worldwide. Patients typically present with chest pain and breathlessness either on exertion or at rest. Cardiac ischaemia can also lead to headache, although this is very rarely its only manifestation. Headache is mostly associated with migraine, cluster and tension headache disorders. More sinister causes include subarachnoid haemorrhage, temporal arteritis, meningitis, venous sinus thrombosis as well as vertebral and carotid artery dissection. A case of headache is presented where the underlying cause was cardiac ischaemia, itself the result of triple vessel coronary artery disease. This, also referred to as cardiac cephalgia, should be suspected in the older patient with risk factors for atherosclerotic disease presenting with recent-onset headache. Diagnosis of this requires high clinical suspicion and is essential for correct patient management.