A headache is generally not listed among the primary or most common warning signs of a heart attack (myocardial infarction). Most head pain episodes, even severe ones, are caused by non-cardiac issues. However, understanding the actual symptoms of a heart attack and recognizing the rare circumstances where head pain connects to a cardiovascular event is important. This information clarifies the true nature of heart attack symptoms and identifies when a headache may signal an associated, time-sensitive medical problem.
Primary Symptoms of a Heart Attack
A heart attack occurs when blood flow to the heart muscle is severely reduced or blocked, usually by a clot in a coronary artery. The most frequent symptom is discomfort in the center of the chest, described as pressure, squeezing, fullness, or pain that lasts more than a few minutes or returns. This discomfort may radiate to the left arm, back, neck, or jaw.
Additional common signs include shortness of breath, which can occur with or without chest discomfort. Patients often experience nausea, vomiting, lightheadedness, or a sudden cold sweat. Generalized weakness or overwhelming fatigue is also frequently reported, sometimes signaling the heart’s compromised ability to circulate blood.
Symptoms can differ significantly between individuals, and women are more likely to experience atypical presentations. Atypical symptoms common in women include unusual tiredness, sleep disturbance, jaw pain, or upper back pain, sometimes without the intense chest pain often seen in men. These subtle non-chest symptoms can unfortunately delay seeking necessary medical care.
When Headache May Relate to Cardiovascular Events
Head pain is not a direct symptom of a heart attack, but it can signal a related cardiovascular emergency or atypical heart ischemia. This includes a hypertensive crisis, where blood pressure suddenly rises to 180/120 mmHg or higher. This spike can trigger a severe headache and is a medical emergency carrying a high risk of causing a stroke, heart attack, or aortic dissection.
In rare cases, cardiac cephalalgia presents as a migraine-like headache caused directly by myocardial ischemia (lack of blood flow to the heart). This headache is often worsened by physical exertion and improves after treatment restores blood flow to the heart muscle. Cardiac cephalalgia can sometimes be the only symptom a patient reports, making diagnosis challenging.
Conditions that predispose individuals to heart events can also involve headaches, such as Spontaneous Coronary Artery Dissection (SCAD), a tear in the heart artery wall that often affects younger women. Migraine is a frequent comorbidity in SCAD patients, suggesting shared risk factors may link the two conditions. In these contexts, the headache is a symptom of a systemic vascular problem or a risk factor for the cardiac event, not the heart attack itself.
Common Causes of Acute Severe Headache
Most acute head pain is attributed to primary headache disorders or common, non-cardiac medical issues. Migraine often presents with throbbing pain, typically on one side of the head, accompanied by sensitivity to light, sound, or nausea. Cluster headaches are characterized by excruciating, piercing pain centered around one eye, often causing tear production and nasal congestion.
Tension headaches, the most common type, usually cause a dull, steady ache felt on both sides of the head, often described as a tight band around the forehead. Other common causes include dehydration, acute sinusitis (causing pressure in the face and forehead), medication overuse, caffeine withdrawal, or strenuous physical exertion.
Immediate Action and Emergency Indicators
Recognizing symptoms that require immediate emergency medical attention is crucial. If classic heart attack symptoms occur—such as sudden, severe chest pain, discomfort spreading to the jaw or arm, or shortness of breath accompanied by cold sweats—call emergency services immediately. Every minute matters in a heart attack, and emergency responders can begin treatment sooner than self-transport allows.
Certain headache features are medical red flags that necessitate an urgent call to emergency services. These include the sudden onset of the “worst headache of your life,” which can suggest a brain bleed. Headaches accompanied by neurological signs like sudden confusion, weakness or numbness on one side, difficulty speaking, or a stiff neck also require immediate evaluation. When in doubt, seek immediate professional help.