title: Primary headache and silent myocardial ischemia in patients with coronary artery disease.
abstract: OBJECTIVE
  The mechanisms by which migraine is linked to ischemic vascular disease remain uncertain and are likely to be complex. The aim of this study was to investigate the correlation between silent myocardial ischemia (SMI) and a history of documented primary headache in a large population of patients with exercise-induced myocardial ischemia.
  
  
  METHODS
  The study involved 1,427 consecutive patients (918 symptomatic and 509 asymptomatic patients) with exercise-induced myocardial ischemia and documented coronary artery disease (CAD).
  
  
  RESULTS
  Patients with anginal symptoms during exercise-induced myocardial ischemia had a significantly higher prevalence of primary headache than those without (41 vs. 30%, p < 0.001). Patients with angina pectoris in daily life also had greater prevalence of primary headache than those without anginal symptoms (37 vs. 20%; p < 0.0001). Symptomatic patients during percutaneous transluminal coronary angiography or myocardial infarction had a greater prevalence of primary headache than asymptomatic patients (p < 0.001 and p = 0.005, respectively).
  
  
  CONCLUSIONS
  Our data suggest that a history of headache in CAD population is correlated to a high probability of anginal symptoms and a decreased probability of SMI. The anamnestic absence of headache requires a close monitoring for patients with risk factors for CAD, because this population seems to have a lower susceptibility to pain and the risk of developing SMI might be increased.
authors.affiliation: Interdepartmental Center of Research in Molecular Medicine, University of Pavia, Italy. colomba.falcone@unipv.it
authors.forename: Colomba
authors.initials: C
authors.lastname: Falcone
authors.forename: Sara
authors.initials: S
authors.lastname: Bozzini
authors.forename: Carmine
authors.initials: C
authors.lastname: Gazzaruso
authors.forename: Margherita
authors.initials: M
authors.lastname: Calcagnino
authors.forename: Natascia
authors.initials: N
authors.lastname: Ghiotto
authors.forename: Rossana
authors.initials: R
authors.lastname: Falcone
authors.forename: Adriana
authors.initials: A
authors.lastname: Coppola
authors.forename: Andrea
authors.initials: A
authors.lastname: Giustina
authors.forename: Gabriele
authors.initials: G
authors.lastname: Pelissero
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D005080:Exercise Test; D005260:Female; D051270:Headache Disorders, Primary / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications*