# Cardiac cephalalgia-headache as an atypical presentation of ST-segment elevation myocardial infarction: a case report

## TL;DR

A man with heart disease risk factors had a severe headache caused by a heart attack, showing that heart issues can sometimes present as headaches.

## Contribution

This case report highlights cardiac cephalalgia as a rare and atypical presentation of ST-segment elevation myocardial infarction.

## Key findings

- A 47-year-old man with diabetes and smoking history presented with a severe headache and was diagnosed with ST-segment elevation myocardial infarction.
- Cardiac cephalalgia was confirmed through electrocardiography and coronary angiography, revealing multivessel coronary artery disease.
- Stenting of affected arteries led to clinical improvement and headache resolution, emphasizing the need to consider cardiac causes in headache presentations.

## Abstract

Ischaemic heart disease commonly presents with chest pain and autonomic symptoms; however, atypical manifestations can occur. Cardiac cephalalgia is a rare presentation of acute coronary syndrome, characterised by a migraine-like headache triggered by myocardial ischaemia. Diagnosis requires a high index of suspicion.

We describe a 47-year-old man with diabetes and a history of smoking who presented with an acute, severe frontotemporal headache accompanied by nausea and vomiting. Electrocardiography revealed ST-segment elevation in the inferior leads. Coronary angiography demonstrated multivessel coronary artery disease involving the right coronary artery and the left anterior descending artery. A subsequent measurement of serum troponin I confirmed myocardial injury. Both arteries were successfully stented, leading to clinical improvement and resolution of the headache.

This case highlights the importance of considering cardiac causes in patients presenting with severe headaches particularly in those with cardiovascular risk factors.

The online version contains supplementary material available at 10.1186/s12872-025-04898-z.