{'fraction_non_alphanumeric': 0.017436791630340016, 'fraction_numerical': 0.011769834350479512, 'mean_word_length': 5.152815013404826, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Cardiac Cephalgia is Not Necessarily an Exertional Headache: Case Report

This 59-year-old-man presented with a 2-year history of episodic headaches. His personal antecedents included hypertension, hypercholesterolaemia and ischaemic cardiopathy diagnosed in March 1998 when he consulted due to exertional angina. Coronary angiogram revealed severe stenosis over the anterior descending coronary artery and the first and second diagonal branches. Percutaneous transluminal angioplasty and stent procedures were successfully carried out for the stenosis of the anterior descending artery and its second diagonal branch, but were not technically possible for the narrowing of the first diagonal. He was discharged on verapamil 180 mg twice a day, aspirin 100 mg daily and simvastatin 20 mg daily. He consulted due to headache for the first time in March 2000 when he complained of an episode of bilateral headache lasting one day. This pain episode was not related to any physical or mental stress, was referred to as rapidly progressive, of dull and throbbing quality and accompanied by some sonophobia, photophobia and nausea. He denied any previous migraine attacks as well as migraine after sublingual nitrates. Neurological exam and CT brain scan were normal and the patient was discharged without a definite diagnosis. He remained asymptomatic until the year 2001 when he was admitted twice, in May and November, due to two prolonged episodes of rest angina without myocardial necrosis. He came again to our Neurology Service in March 2002 as his headache attacks had reappeared. Over the previous three months he had experienced five episodes of bilateral, most marked in vertex and occipital areas, moderate– severe pain, always during rest. The first three episodes subsided spontaneously in several hours. In the fourth episode he noticed, about one hour after the beginning of the headache, some chest discomfort and slight diaphoresis. He came to the Emergency Ward where ST-segment depression was seen in his ECG. Both the ECG changes and headache only disappeared when he took two sublingual tablets of nitroglycerin. In the fifth episode cranial pain resolved again after sublingual nitrates. Except for duration, however, all episodes were similar in characteristics to the first.