Should acute myocardial infarction be considered in the differential diagnosis of headache?

OBJECTIVE

Headache as the only presenting symptom of acute myocardial infarction (MI) is an extremely uncommon phenomenon. The aim of this report is to describe a 61 year-old female patient with exertional headaches being the solely presentation of acute MI.

METHODS

As there were no complaints of chest pains or any other symptoms suggestive for MI, she underwent extensive neurological work-up. The correct diagnosis, however, was established only after a detailed description of the localization and radiation of her pains was obtained.

CONCLUSIONS

The importance of a thoroughly obtained anamnesis for the early recognition of cases with MI presenting with headaches, as well as the difference of opinion concerning the correct diagnosis which may occur between the internist and the cardiologist, are discussed.