What is the relationship between headache and hypertension (high blood pressure)?

From the Guidelines

If you're experiencing headaches with high blood pressure, you should seek medical attention promptly and take your prescribed blood pressure medications as directed, such as ACE inhibitors (like lisinopril) or ARBs (such as losartan), to manage the condition and prevent complications like stroke or organ damage 1.

Immediate Management

For immediate management, common medications include:

• ACE inhibitors (like lisinopril)
• ARBs (such as losartan)
• Calcium channel blockers (amlodipine)
• Diuretics (hydrochlorothiazide) Typical dosages vary by individual needs. While waiting for medical help, rest in a quiet, dark room and practice slow, deep breathing.

Lifestyle Modifications

To manage high blood pressure and prevent headaches, consider the following lifestyle modifications:

• Reduce salt intake and avoid high-salt foods 2
• Eat a healthy diet rich in whole grains, fruits, vegetables, polyunsaturated fats, and dairy products
• Limit alcohol consumption to 2 standard drinks for men and 1.5 for women per day
• Maintain a healthy weight and avoid obesity
• Engage in regular physical activity, such as moderate-intensity aerobic exercise or strength training
• Reduce stress and practice mindfulness or meditation ### Monitoring and Prevention Regular monitoring with a home blood pressure device is recommended, with readings ideally below 120/80 mmHg. Headaches occur because extremely high blood pressure can force blood against vessel walls, causing pain receptors to activate. Persistent headaches with high blood pressure readings above 180/120 mmHg could indicate a hypertensive emergency requiring immediate emergency care, as this condition can lead to serious complications like stroke or organ damage 1. Some key points to consider:
• High blood pressure is a leading risk factor for cardiovascular disease morbidity and mortality 1
• Lifestyle modifications, such as reducing salt intake and increasing physical activity, can help manage high blood pressure 2
• Medications, such as ACE inhibitors and ARBs, can help lower blood pressure and prevent complications 1

From the Research

Headache and Blood Pressure

• Headache associated with arterial hypertension is a significant concern in emergency departments, and it is believed that headache may be a symptom attributed to arterial hypertension only if the BP values are very high or rise quickly 3.
• Many studies support the hypothesis that migraine patients have an increased risk of developing hypertension, while hypertensive subjects do not seem to have an increased risk of migraine or other types of headache 3.
• The relationship between chronic hypertension and headache, particularly migraine, is complex and multifactorial, with some studies suggesting a link between the two 4.

Mechanisms and Pathophysiology

• Migraine and arterial hypertension may share common mechanisms like endothelial dysfunction, deficiency of autonomic cardiovascular regulation, and renin-angiotensin system involvement 3.
• The pathophysiology underlying the onset of headache as it relates to abrupt rises in blood pressure seems to lie at the cellular level and mechanically becomes an issue with disruption of the blood-brain barrier 4.

Treatment and Management

• Preventive effects of migraine have been described by several antihypertensive agents, traditionally beta-blockers, and more recently angiotensin-converting-enzyme inhibitors and angiotensin II receptor blockers 3.
• The use of diuretics, beta blockers, angiotensin-converting enzyme inhibitors, and calcium channel blockers in older patients with hypertension is common, with calcium channel blockers being the most frequently used antihypertensive drugs 5.

Pain and Blood Pressure

• The perspective that pain corresponds to elevated blood pressure is overly simplistic, and prolonged pain and migraine's effect on blood pressure varies and can result in lower-than-expected blood pressure 6.
• Comorbid pain and chronic hypertension have a higher concurrence than in the general population, and a better understanding of pain's effect on blood pressure will help practitioners appropriately diagnose and counsel patients without disproportionately attributing high blood pressure to pain 6.