Unmasking a Cardiac Culprit in a Patient with Persistent Headache

Cardiac cephalalgia is a rare and underrecognized manifestation of myocardial ischemia that may present without typical chest pain, leading to diagnostic delay. We report a 52-year-old gentleman who presented with a 4-day history of persistent holocranial headache without prior comorbidities. He was prescribed antihypertensives based on a single reading of high blood pressure. However, the persistence of symptoms prompted further assessment. Electrocardiography and positive troponin I confirmed an inferoposterior ST-elevation myocardial infarction. Neuroimaging was unremarkable. Coronary angiography revealed a left-dominant system with occlusion of the left posterolateral branch, for which urgent percutaneous coronary intervention with stenting was performed. The patient’s headache resolved completely within 2 h postrevascularization, confirming the diagnosis of cardiac cephalalgia. This case highlights the importance of considering cardiac causes in atypical headache presentations. Early recognition is critical, as misdiagnosis may delay lifesaving treatment and expose patients to contraindicated therapies such as vasoconstrictive agents.