From the Guidelines
No, a headache caused by hypertension is not typically classified as a vascular headache. Hypertension-related headaches are generally categorized as secondary headaches, meaning they occur as a symptom of another underlying condition (in this case, high blood pressure) 1. Vascular headaches, on the other hand, primarily refer to migraines and cluster headaches, which involve abnormal function of blood vessels but through different mechanisms than hypertension.
Key Points to Consider
- Hypertension typically causes headaches only when blood pressure is severely elevated (hypertensive crisis), leading to what's called a hypertensive headache, as outlined in the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1.
- These headaches often present as throbbing pain, frequently in the back of the head, and may be accompanied by other symptoms of severely high blood pressure such as vision changes, nausea, or confusion.
- The mechanism involves the extreme pressure forcing blood vessels to dilate beyond their normal capacity, triggering pain receptors.
- If you're experiencing recurring headaches that you suspect might be related to high blood pressure, it's essential to have your blood pressure monitored and seek medical attention, especially if the headache is severe or accompanied by other concerning symptoms, as emphasized in the ESC Council on Hypertension position document on the management of hypertensive emergencies 2.
Clinical Implications
- It's crucial to differentiate between hypertensive headaches and other types of headaches to provide appropriate management and prevent potential complications.
- The diagnosis of hypertensive emergency, which may include headache as a symptom, relies on the presence of acute hypertension-mediated target organ damage, as stated in the 2024 ESC guidelines 1.
- Prompt recognition and treatment of hypertensive emergencies are vital to reduce morbidity and mortality, and improve quality of life.
From the Research
Headache and Hypertension
- Headache is not generally regarded as a symptom of high blood pressure, with most studies showing that mild chronic hypertension and headache are not associated 3, 4.
- However, headaches caused by significant disturbances in arterial pressure are included in the section "Headache attributed to a disorders of homeostasis" (code 10.3) of the 2nd edition of the International Classification of Headache disorders 3.
- It is believed that headache may be a symptom attributed to arterial hypertension only if the BP values are very high or rise quickly 5.
Vascular Headache
- There is no direct evidence to suggest that headache caused by hypertension is called vascular headache.
- However, migraine and arterial hypertension may share common mechanisms like endothelial dysfunction, deficiency of autonomic cardiovascular regulation and renin angiotensin system involvement 5.
- The relationship between headache and hypertension has been debated for many years, with some studies suggesting a link between the two, while others have found no association 3, 4, 6.
Classification of Headache
- Headaches caused by significant disturbances in arterial pressure are included in the section "Headache attributed to a disorders of homeostasis" (code 10.3) of the 2nd edition of the International Classification of Headache disorders 3.
- Hypertensive encephalopathy, followed by seizures, focal neurological deficits and loss of consciousness, is a condition that can cause headache 4.