Chest Pain A Manifestation of Migraine

• Published in: The Journal of emergency medicine 2014-03, Vol.46 (3), p.420-427
• Main Author: Roldan, Carlos J., MD, FACEP, FAAEM
• Format: Article
• Language: English
• Subjects: Adult; Akathisia, Drug-Induced - etiology; allodynia; Analgesics, Opioid - therapeutic use; chest pain; Chest Pain - drug therapy; Chest Pain - etiology; Dopamine Antagonists - adverse effects; Dopamine Antagonists - therapeutic use; Electrocardiography; Emergency; Female; Follow-Up Studies; Humans; Male; Metoclopramide - adverse effects; Metoclopramide - therapeutic use; Middle Aged; migraine; Migraine Disorders - complications; Migraine Disorders - drug therapy; Nitroglycerin - therapeutic use; Pain Measurement; Recurrence; Registries; Thoracic Wall; visual analog scale; Young Adult
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2013.08.019

Abstract Background Chest pain is an alarming symptom; it justifies many visits to the emergency department (ED). The etiology is often unknown. Chest wall pain in the presence of migraine headache, although not a common occurrence, is intriguing when it resolves with antimigraine treatment. Objectives To characterize the manifestations and outcomes and investigate the relationship between chest wall pain and headache as a manifestation of migraine exacerbation. Methods Among patients visiting our ED, we identified those individuals whose pain originated in the chest wall in the setting of migraine exacerbation. Patients with clinical indications for specific treatments were dispositioned accordingly. Control of symptoms including chest pain and headache with antimigraine agents was considered the primary outcome. A prospective follow-up via telephone interview and medical records review was performed. Results We collected a convenience sample of 33 patients. All manifested migraine headache with an earlier onset than the chest pain, and all had taken medications prior to visiting the ED. Twelve patients reported a higher visual analog scale score for the headache than for the chest pain. Still, chest pain was the main complaint. The chest pain originated at the chest wall. Ten patients received sublingual nitroglycerin or opiates, or both; no pain relief was reported. However, all symptoms resolved with metoclopramide. On follow-up, 6 patients reported recurrence of chest pain with subsequent migraines. Conclusions Chest pain can be a complication of migraine. The treatment should be focused on migraine control. Migraine should be included in the differential diagnosis of chest pain.