What are the other Names for this Condition? (Also known as/Synonyms)

• CC (Cardiac Cephalalgia)

What is Cardiac Cephalalgia? (Definition/Background Information)

• Cardiac Cephalalgia (CC) is a headache disorder that occurs secondary to acute myocardial ischemia that is a heart condition of reduced blood flow to the heart, which prevents the heart muscles from receiving sufficient oxygen. The condition generally causes a migraine-like headache that is relieved by nitroglycerine medications
• The onset of the moderate to severe intensity headache is during an episode of myocardial ischemia. It may be associated with nausea and precipitated by physical activities or exertion. However, no increased sensitivity to sound or light is observed

The criteria for diagnosis of Cardiac Cephalalgia as outlined by the International Headache Society (IHS) is given below:

• Acute myocardial ischemia has been demonstrated
• Any headache fulfilling the criterion below

Evidence of causation demonstrated by at least two of the following:

• Headache has developed in temporal relation to the onset of acute myocardial ischemia
• Either or both of the following:
  • Headache has significantly worsened in parallel with worsening of the myocardial ischemia
  • Headache has significantly improved or resolved in parallel with improvement in or resolution of the myocardial ischemia
• Headache has at least two of the following four characteristics:
  • Moderate to severe intensity
  • Accompanied by nausea
  • Not accompanied by photophobia or phonophobia
  • Aggravated by exertion
• Headache is relieved by nitroglycerine or derivatives of it

Not better accounted for by another ICHD-3 diagnosis.

(Source: International Headache Society Classification ICHD-3, London, United Kingdom)

Differential diagnosis: It is very important to exclude migraine without aura prior to arriving at a definitive diagnosis of Cardiac Cephalalgia (CC), since both have widely varying treatment medications. Sometimes, the treatment medications for CC is contraindicated in migraine without aura. Individuals who have migraine without aura can be treated with vasoconstrictor medications which is contraindicated in ischemic heart disease.

It is also important to note that migraine-like headache may be triggered by vasodilators, such as nitroglycerine, given for anginal chest pain. Hence, an appropriate classification of headache is paramount before initiation of treatment.