What blood pressure medicines, including both brand names (e.g. Norvasc, Adalat) and generic names (e.g. amlodipine, nifedipine), have severe headaches as a possible side effect?

Blood Pressure Medications That Cause Severe Headaches

Several calcium channel blockers (CCBs), particularly dihydropyridines, are the blood pressure medications most commonly associated with severe headaches as a side effect. 1

Calcium Channel Blockers with Headache as a Common Side Effect

Dihydropyridine CCBs

• Amlodipine (Norvasc) - Headache is listed as one of the primary side effects 1
• Felodipine (Plendil) - Headache is a common side effect 1
• Isradipine (DynaCirc) - Associated with headache and fatigue 1
• Nicardipine (Cardene) - Causes headache, dizziness, and flushing 1
• Nifedipine (Adalat, Procardia) - Associated with headache, particularly the immediate-release formulation 1, 2
• Nisoldipine (Sular) - Has similar side effects to nifedipine, including headache 1
• Nitrendipine - Has similar side effects to nifedipine, including headache 1

Non-Dihydropyridine CCBs

• Diltiazem (Cardizem, Tiazac) - Can cause headache, though less commonly than dihydropyridines 1
• Verapamil (Calan, Isoptin) - Can cause headache, though less commonly than dihydropyridines 1

Mechanism of Headache with CCBs

The headaches associated with calcium channel blockers are primarily due to their vasodilatory effects:

• CCBs cause arterial dilation, which can trigger headaches similar to migraine mechanisms 2
• Dihydropyridines (like amlodipine and nifedipine) have the most pronounced peripheral vasodilatory effects and therefore tend to cause more headaches than non-dihydropyridines (like diltiazem and verapamil) 1, 2
• The immediate-release formulations (particularly of nifedipine) are more likely to cause severe headaches due to rapid onset of action and more pronounced vasodilation 1, 3

Other Blood Pressure Medications That May Cause Headaches

Alpha-1 Blockers

• Prazosin, Doxazosin, Terazosin - Can cause headache due to vasodilation, though less commonly reported than with CCBs 4

Vasodilators

• Hydralazine - Direct vasodilator that can cause headache and flushing 1
• Minoxidil - Potent vasodilator that may cause headache 1

Nitrates (used for angina but also lower blood pressure)

• Nitroglycerin - Commonly causes headache due to vasodilation 1
• Isosorbide dinitrate/mononitrate - Frequently associated with headache 4

Blood Pressure Medications Less Likely to Cause Severe Headaches

• Beta-blockers (metoprolol, atenolol, propranolol) - Generally do not cause headaches; may actually prevent them 1, 5
• ACE inhibitors (enalapril, lisinopril) - Headache is not a common side effect 6
• Angiotensin II receptor blockers (valsartan, losartan) - Headache is not commonly reported 7
• Thiazide diuretics (hydrochlorothiazide) - Rarely associated with headache 5

Clinical Considerations

• If a patient develops severe headaches on a dihydropyridine CCB, consider:

  1. Switching to a non-dihydropyridine CCB (diltiazem or verapamil) 1
  2. Switching to a different class of antihypertensive medication 1
  3. For patients who need to remain on a dihydropyridine CCB, using an extended-release formulation may reduce headache severity 1

• Paradoxically, some studies suggest that blood pressure medications may actually prevent headaches in many patients, with a meta-analysis showing that blood pressure-lowering drugs reduced headache prevalence by about one-third compared to placebo 5

• In pregnancy, extended-release nifedipine and labetalol are first-line agents, but if headaches occur with nifedipine, switching to labetalol may be beneficial 1

• Headaches are most common during initiation of therapy and may diminish over time as the body adjusts to the medication 2