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      Cardiac cephalalgia: one case with cortical hypoperfusion in headaches and literature review

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          Abstract

          Background

          Cardiac cephalalgia (CC) is a rare disease occurring during an episode of myocardial ischemia and relieved by nitroglycerine. Though more than 30 cases of CC have been reported since 1997, the mechanism is yet obscure. Herein, a case of CC is presented and discussed in relevance with previous literature to propose a novel hypothesis about the mechanism of CC.

          Method

          A CC patient with cortical hypoperfusion during headache attacks was presented, which has never been reported. All published cases of CC via PubMed ( http://www.ncbi.nlm.nih.gov/pubmed) in English literature, between 1997 and 2016, were reviewed.

          Results

          A patient suffering from CC presented a cerebral hypoperfusion during a headache attack. This phenomenon had not been observed since CC was introduced in 1997. The literature review summarized the clinical presentations, neuroimaging features, ECG, and coronary angiography features of 35 CC patients.

          Conclusion

          Based on the phenomenon of hypoperfusion in the event of a headache, the vessel constriction hypothesis was proposed including two potential physiological mechanisms underlying the pathophysiology of CC.

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          Most cited references 52

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          The International Classification of Headache Disorders, 3rd edition (beta version).

            (2013)
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            The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients.

            Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by the association of severe headaches with or without additional neurological symptoms and a 'string and beads' appearance on cerebral arteries, which resolves spontaneously in 1-3 months. We present the clinical, neuroimaging and outcome data of 67 consecutive patients prospectively diagnosed over 3 years in our institution with an angiographically confirmed RCVS. There were 43 females and 24 males with a mean age of 42 years (19-70). RCVS was spontaneous in 37% of patients and secondary in the 63% others, to postpartum in 5 and to exposure to various vasoactive substances in 37, mainly cannabis, selective serotonin-recapture inhibitors and nasal decongestants. The main pattern of presentation (94% of patients) was multiple thunderclap headaches recurring over a mean period of 1 week. In 51 patients (76%), headaches resumed the clinical presentation. Various complications were observed, with different time courses. Cortical subarachnoid haemorrhage (cSAH) (22%), intracerebral haemorrhage (6%), seizures (3%) and reversible posterior leukoencephalopathy (9%) were early complications, occurring mainly within the first week. Ischaemic events, including TIAs (16%) and cerebral infarction (4%), occurred significantly later than haemorrhagic events, mainly during the second week. Significant sex differences were observed: women were older, had more frequent single-drug exposure and a higher rate of stroke and cSAH. Sixty-one patients were treated by nimodipine: 36% had recurrent headaches, 7% TIAs and one multiple infarcts. The different time courses of thunderclap headaches, vasoconstriction and strokes suggest that the responsible vasospastic disorder starts distally and progresses towards medium sized and large arteries. No relapse was observed during the 16 +/- 12.4 months of follow-up. Our data suggest that RCVS is more frequent than previously thought, is more often secondary particularly to vasoactive substances, and should be considered in patients with recurrent thunderclap headaches, cSAH or cryptogenic strokes with severe headaches.
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              Activation of central trigeminovascular neurons by cortical spreading depression.

              Cortical spreading depression (CSD) has long been implicated in migraine attacks that begin with visual aura. Having shown that a wave of CSD can trigger long-lasting activation of meningeal nociceptors--the first-order neurons of the trigeminovascular pathway thought to underlie migraine headache--we now report that CSD can activate central trigeminovascular neurons in the spinal trigeminal nucleus (C1-2). Stimulation of the cortex with pinprick or KCl granule was used to induce CSD in anesthetized rats. Neuronal activity was monitored in C1-2 using single-unit recording. In 25 trigeminovascular neurons activated by CSD, mean firing rate (spikes/s) increased from 3.6 ± 1.2 before CSD (baseline) to 6.1 ± 1.8 after CSD (p 13 minutes. Neuronal activity returned to baseline level after 30.0 ± 3.1 minutes in 14 units, and remained elevated for 66.0 ± 8.3 (22-108) minutes through the entire recording period in the other 11 units. Neuronal activation began within 0.9 ± 0.4 (0-2.5) minutes after CSD in 7 neurons located in laminae I-II, or after a latency of 25.1 ± 4.0 (7-75) minutes in 9 neurons located in laminae I-II, and 9 neurons located in laminae III-V. In 27 trigeminovascular neurons not activated by CSD, mean firing rate was 2.0 ± 0.7 at baseline and 1.8 ± 0.7 after CSD. We propose that CSD constitutes a nociceptive stimulus capable of activating peripheral and central trigeminovascular neurons that underlie the headache of migraine with aura. Copyright © 2011 American Neurological Association.
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                Author and article information

                Affiliations
                [1 ]ISNI 0000 0004 1761 8894, GRID grid.414252.4, The Department of Geriatric Neurology, , Chinese PLA General Hospital, ; Beijing, China
                [2 ]GRID grid.414889.8, The Outpatient Department of Fuxing Road No. 7, , the First Affiliated Hospital of PLA General Hospital, ; Beijing, China
                [3 ]ISNI 0000 0004 1761 8894, GRID grid.414252.4, The Department of of Cardiology, , Chinese PLA General Hospital, ; Beijing, China
                [4 ]ISNI 0000 0004 1761 8894, GRID grid.414252.4, The Department of of Radiology, , Chinese PLA General Hospital, ; Beijing, China
                [5 ]ISNI 0000 0004 1761 8894, GRID grid.414252.4, Department of Neurology, , Chinese PLA General Hospital, ; Fuxing Road 28, Haidian District, Beijing, 100853 China
                Contributors
                wangmiao4236@163.com
                luwang6@126.com
                liucf301@126.com
                xiangbing_bian@163.com
                +86-10-55499318 , dong_zhaozhao@126.com
                yusy1963@126.com
                Journal
                J Headache Pain
                J Headache Pain
                The Journal of Headache and Pain
                Springer Milan (Milan )
                1129-2369
                1129-2377
                20 February 2017
                20 February 2017
                2017
                : 18
                : 1
                28220375 5318311 732 10.1186/s10194-017-0732-3
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                Funding
                Funded by: National Scientific Research Fund of China
                Award ID: 81471147
                Award Recipient :
                Funded by: National Scientific Research Fund of China
                Award ID: 81471146
                Award Recipient :
                Funded by: the Capital Development Scientific Research
                Award ID: 2014-4-5013
                Award Recipient :
                Categories
                Review Article
                Custom metadata
                © The Author(s) 2017

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