Acute myocardial ischemia may be associated with headache.


Patient selection: headache


Features of cardiac cephalgia:

(1) The patient has headaches.

(2) The patient has acute myocardial ischemia (as evidence by changes on ECG or serum troponin concentration).

(3) Presence of 2 or more of the following:

(3a) The headache occurs with a temporal relation to the myocardial ischemia.

(3b) The headache is relieved by nitroglycerin or related drug.

(3c) (The headache gets worse if the myocardial ischemia becomes worse.) OR (The headache improves with resolution of myocardial ischemia by coronary revascularization, etc.)

(3d) The headaches have >= 2 of the following:

(3d1) severe intensity

(3d2) nausea

(3d3) absence of photophobia and phonophobia

(3d4) aggravated by exertion (if it worsens myocardial ischemia)

(4) No other explanation can explain the headaches better.


It may be related to atherosclerosis involving multiple coronary arteries.


Cardiac stress testing can be helpful to correlate the headache and myocardial ischemia.


To read more or access our algorithms and calculators, please log in or register.