Features:
(1) The patient has underlying coronary artery disease, which may or may not be recognized.
(2) There is no specific localization for the headache.
(3) The headache is episodic and often lasts only a few minutes.
(4) The headache tends to resolve spontaneously.
(5) The patient may have concurrent chest pain.
(6) The headache may be exercise- or exertion-induced, with resolution upon rest.
(7) The patient has risk factors for coronary artery disease.
A simple clinical test is to treat the patient with nitroglycerin while the patient is experiencing a headache. Headache induced by coronary artery disease is typically relieved by the nitroglycerin.
If the diagnosis is suspected, then an exercise stress test is recommended.
