What is the treatment for a headache associated with hypertension (high blood pressure)?

From the Guidelines

To treat a hypertensive headache, immediate blood pressure lowering with intravenous labetalol, oral methyldopa, or nifedipine is recommended for severe hypertension, as per the 2024 ESC guidelines 1. When managing hypertensive headaches, it's crucial to consider the severity of the hypertension and the presence of any acute cerebrovascular events.

• In patients with acute intracerebral haemorrhage, immediate BP lowering is not recommended for patients with systolic BP <220 mmHg, but careful acute BP lowering with i.v. therapy to <180 mmHg should be considered in patients with systolic BP ≥220 mmHg 1.
• For hypertensive patients with an acute cerebrovascular event, anti-hypertensive treatment is recommended immediately for TIA, and after several days in ischemic stroke 1. Key considerations for treating hypertensive headaches include:
• Lowering blood pressure with medications like labetalol, methyldopa, or nifedipine, as recommended by the 2024 ESC guidelines 1
• Managing pain with over-the-counter medications like acetaminophen or ibuprofen, if not contraindicated
• Practicing relaxation techniques, such as deep breathing, to help reduce stress and blood pressure
• Seeking emergency care if blood pressure exceeds 180/120 mmHg or if severe headache is accompanied by vision changes, confusion, chest pain, or difficulty breathing. Intravenous hydralazine is a second-line option for severe hypertension, according to the 2024 ESC guidelines 1.

From the FDA Drug Label

1 INDICATIONS & USAGE 1. 1 Hypertension Amlodipine besylate tablets is indicated for the treatment of hypertension, to lower blood pressure.

High Blood Pressure (hypertension) High blood pressure comes from blood pushing too hard against your blood vessels. Amlodipine besylate relaxes your blood vessels, which lets your blood flow more easily and helps lower your blood pressure.

To treat hypertensive headache, the primary approach is to lower blood pressure.

• Amlodipine besylate can be used to treat hypertension by relaxing blood vessels and improving blood flow, which in turn can help alleviate headaches caused by high blood pressure.
• It is essential to follow the prescribed dosage and administration instructions for amlodipine besylate 2, 2.
• Patients should consult their doctor for specific advice on managing hypertension and associated symptoms like headaches.

From the Research

Treatment of Hypertensive Headache

• The relationship between headache and hypertension is complex and multifactorial, with some studies suggesting a link between chronic hypertension and headache, particularly migraine 3.
• Hypertensive headache is not a formally defined headache entity, but it is often associated with abrupt rises in blood pressure and disruption of the blood-brain barrier 3.
• Treatment of hypertensive headache typically involves managing the underlying hypertension, with lifestyle modifications such as weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption 4.
• First-line drug therapy for hypertension consists of a thiazide or thiazide-like diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker, which can help reduce blood pressure and alleviate headache symptoms 4, 5.
• Acute treatment of migraine, which is often associated with hypertensive headache, includes acetaminophen, nonsteroidal anti-inflammatory drugs, and combination products that include caffeine, as well as migraine-specific treatments such as triptans and gepants 6.
• Preventive treatments for migraine, such as antihypertensives, antiepileptics, antidepressants, calcitonin gene-related peptide monoclonal antibodies, and onabotulinumtoxinA, can also help reduce the frequency and severity of hypertensive headaches 6.

Management of Hypertension

• Lifestyle modification is the first-line therapy for hypertension, consisting of weight loss, dietary sodium reduction and potassium supplementation, healthy dietary pattern, physical activity, and limited alcohol consumption 4.
• When drug therapy is required, first-line therapies are thiazide or thiazide-like diuretics, angiotensin-converting enzyme inhibitor or angiotensin receptor blockers, and calcium channel blockers, which can help reduce blood pressure and alleviate headache symptoms 4, 5.
• The choice of antihypertensive medication should be based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease risk, as well as the patient's individual characteristics and medical history 4.

Safety and Efficacy of Antihypertensive Medications

• Beta-blockers, calcium channel blockers, and angiotensin receptor blockers are commonly used antihypertensive medications that have been shown to be effective and safe in reducing blood pressure and alleviating headache symptoms 5.
• A prospective study found that these medications had similar efficacy in reducing systolic blood pressure, with no significant adverse reactions observed in either class of medicines 5.
• Calcium channel blockers were found to be superior to other medications in reducing diastolic blood pressure, although the difference was not significant 5.