Accurate diagnosis of cardiac cephalalgia necessitates distinguishing its unique characteristics from other headache types, including migraine and secondary head­aches [6]. Recognizing the epidemiological prole of this condition is crucial for clinical awareness in potentially affected patients. Cardiac cephalalgia primarily affects individuals over 50 years of age, and a male predominance is observed, attributed potentially to a higher prevalence of cardiovascular risk factors [4, 16]. Concurrent cardiovascular risk factors, such as hypertension, coronary artery dis­ease, and diabetes mellitus, are common [14].

non-steroidal anti-inammatory drugs (NSAIDs), are not indicated. Triptans are formally contraindicated [2, 6]. Treatment modalities for cardiac cephalalgia range from intravenous medications, such as nitroglycerin, to invasive procedures, includ­ing percutaneous coronary intervention (PCI). Literature reviews consistently high­light nitrates, particularly nitroglycerin, as the rst-line treatment for cardiac headache relief. Nitroglycerin can be administered via sublingual or intravenous routes [1, 6]. For sublingual administration, a 0.4mg dose is recommended, with response observed within approximately 30 minutes. Intravenous administration should begin with 5–10μg/minute, titrated based on patient response, utilizing an infusion pump. The maximum dose is typically 400μg/minute. Continuous moni­toring of blood pressure and heart rate is essential during administration. Nitroglycerin’s efcacy stems from its vasodilatory properties, which reduce car­diac afterload and improve venous return. This enhances blood ow to ischemic myocardial cells, alleviating the referred headache [36]. The response to vasodila­tors, particularly nitrates such as nitroglycerin, is a pivotal aspect in supporting the diagnosis of cardiac headache and differentiating it from conditions like migraine [4, 16]. Cardiac headache, originating from myocardial ischemia, typically resolves with coronary vasodilation. This response contrasts sharply with migraine, where vasodilators are generally ineffective and usually trigger or exacerbate symptoms [4, 16]. Therefore, a positive response to vasodilators not only provides therapeutic benet but also serves as a crucial diagnostic clue, helping to distinguish cardiac headache from other primary headache disorders. Additional treatments for acute myocardial ischemia, as described in the literature, include brinolytic agents and invasive procedures like PCI.These interventions aim to restore coronary blood ow, thereby resolving headaches through the previously described pathophysio­logical mechanisms [4].