High blood pressure and headache
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High Blood Pressure and Headache: Association and Patterns
Frequency and Characteristics of Headache in High Blood Pressure
Headaches are more common in people with very high diastolic blood pressure (130 mm Hg or above). These headaches are usually diffuse, occur in the morning, and often improve after a few hours or when blood pressure is controlled. However, people with lower diastolic blood pressure (below 130 mm Hg) do not have more headaches than those with normal blood pressure. If a person with high blood pressure has an occipital headache that does not improve with blood pressure control, other causes like cervical spondylosis should be considered 1.
Blood Pressure and Chronic Daily Headache
Studies comparing women with and without chronic daily headache found no significant differences in their blood pressure readings, whether measured in the clinic or over 24 hours. This suggests that chronic daily headache is not directly linked to higher blood pressure 2.
Large-Scale Population Studies: Conflicting Results
Some large studies have found no clear relationship between blood pressure and symptoms like headache, epistaxis (nosebleeds), or tinnitus. Headaches were not more common in people with higher blood pressure, except in those with signs of retinopathy (eye damage from high blood pressure) 3. Other research found that people with higher systolic and diastolic blood pressure actually had a lower risk of non-migrainous headaches over time, possibly due to a phenomenon called hypertension-associated hypalgesia, where higher blood pressure reduces pain sensitivity 710.
Emergency Department and Migraine Patients
In emergency departments, people presenting with headache are more likely to have elevated blood pressure compared to those with other complaints. However, improvement in headache pain is not linked to improvement in blood pressure, and having high blood pressure does not make people less likely to respond to standard migraine treatments 4.
Hypertensive Headache: Secondary Headache Disorders
Headache is generally considered a symptom of high blood pressure only when blood pressure is very high or rises quickly. The relationship between chronic hypertension and headache, especially migraine, is complex and not fully understood. Some evidence suggests that abrupt increases in blood pressure can cause headaches due to changes at the cellular level and disruption of the blood-brain barrier 58.
Migraine and Hypertension: A Complicated Relationship
The link between migraine and high blood pressure is controversial. Some studies show that people with migraine are at higher risk of developing hypertension, but not the other way around. The association is stronger for higher diastolic blood pressure, but findings are inconsistent for systolic blood pressure. Both conditions may share underlying mechanisms, such as problems with blood vessel function and the autonomic nervous system 68.
Blood Pressure-Lowering Drugs and Headache Prevention
Meta-analyses of blood pressure-lowering drugs show that these medications reduce the frequency of headaches, regardless of the drug class. This suggests that lowering blood pressure itself helps prevent headaches. However, observational studies do not consistently support the idea that high blood pressure causes headaches 9.
Pulse Pressure and Headache Prevalence
Higher pulse pressure (the difference between systolic and diastolic blood pressure) is linked to a lower prevalence of both migraine and non-migrainous headaches. This effect is thought to be due to increased arterial stiffness and the activation of the baroreflex, which reduces pain sensitivity 10.
Conclusion
The relationship between high blood pressure and headache is complex. Headaches are more common only in cases of very high or rapidly rising blood pressure. In general, people with high blood pressure do not have more headaches than those with normal blood pressure, and some studies even suggest a lower risk of certain headaches in people with higher blood pressure. Blood pressure-lowering medications can help prevent headaches, but the direct cause-and-effect relationship remains unclear. The association between migraine and hypertension is particularly complicated and may involve shared biological mechanisms.
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