Paroxysmal toothache after drinking: alcohol-induced vasospastic angina

Vasospastic angina is caused by transient abnormal contraction of the coronary arteries. Episodes last for 5-15 minutes and are most common in the late evening and early morning.In some patients with vasospastic angina, attacks occur only on drinking days, several hours after drinking. Alcohol-induced vasospastic angina is thought to be attributable to a functional disorder of vascular smooth muscle caused by acetaldehyde accumulation due to alcohol metabolism or transient coronary artery spasm associated with magnesium deficiency and increased endothelin-1 activity.Vasospastic angina can manifest as pain in the head and neck, teeth, arms and shoulders, and is often accompanied by chest pain. However, toothache can be the only symptom and is often bilateral, as in this case.