The pain of myocardial ischemia is often referred to structures outside the thorax. We studied a patient with angina pectoris who had recurrent bregmatic headache as the initial and most severe symptom of cardiac ischemia.
REPORT OF A CASE
A 62-year-old man had a three-month history of episodic bregmatic headache with associated retrosternal pain and occasional numbness of both arms. He described his headaches as being so severe he felt as if his head would explode. Substernal tightness invariably followed the headache by several seconds, was initially of mild severity, but gradually worsened. The headache and chest pain never occurred independently of one another. These attacks were precipitated by stress and exertion. Two such episodes were witnessed, during which the blood pressure transiently increased to 180/110 mm Hg. Both attacks were terminated within 30 to 60 s with 0.4 mg of sublingual nitroglycerin. Results of physical examination were unremarkable.
Lefkowitz D, Biller J. Bregmatic Headache as a Manifestation of Myocardial Ischemia. Arch Neurol. 1982;39(2):130. doi:10.1001/archneur.1982.00510140064019
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