Despite the progress in the laboratory detection of acute myocardial infarction (AMI), medical history remains the most important diagnostic step in order to establish the diagnosis. Most patients with AMI describe a severe, pressure-type pain in the mid-sternum, often radiating to the left arm, neck or jaw. The pain resembles angina, but it can be distinguished from it by its intensity, duration (>30 min), and failure to resolve with nitroglycerin administration. The pain may also be accompanied by nausea, vomiting and diarrhea, especially when the infarction is located in the inferior wall. Other symptoms include dyspnea, diaphoresis, dizziness, palpitations, cold perspiration, profound weakness and syncope. The diagnosis of AMI may be difficult when atypical symptoms occur, such as indigestion, unusual localization of the pain, agitation and altered mental status. Furthermore, AMI may be silent in more than 25% of cases, in which the infarction is not recognized by the patient and evidence of the infarction is provided by the electrocardiogram or post-mortem examination. Asymptomatic infarction occurs more frequently in elderly patients with hypertension, angina pectoris, and, mostly, diabetes mellitus, as a result of the polyneuropathy that accompanies long-standing and uncontrolled diabetes. We describe here a case which presented to ED with severe headache accompanied with nausea, vertigo. During routine investigation, ECG was done which showed ST elevation in lead II,III, AVF and showed marked ST-segment depression in leads V1 to V5 and slight ST-segment depression in leads I and aVL. So headache was the sole symptom of AMI which was very rare. 

Keywords: Myocardial Infarction; Headache; Vertigo; Chest Pain; Nausea.