Myths Connect Hypertension and Headaches

Article excerpt

SAN FRANCISCO -- Hypertension causes headaches. Treating hypertension decreases headaches. Headaches increase the risk for stroke and heart disease.

Really? Not quite, Dr. Dara G. Jamieson said at the annual meeting of the American Society of Hypertension.

The reality is more nuanced:

* Acute hypertension can cause headache in some cases, but chronic hypertension does not.

* Treating chronic hypertension possibly decreases headaches, and treating acute hypertension can decrease headaches in some cases.

* General headaches or migraines without aura do not increase risk for stroke or heart disease, but risks for these cardiovascular problems are increased in patients who get migraines with aura, especially in women, said Dr. Jamieson of Cornell University, Ithaca, N.Y.

She described in more detail the scenarios that clinicians need to think about in the interface between hypertension and headaches.

* Hypertension causing headaches. A common misconception (especially among patients) that hypertension causes headaches derives from long-standing misinterpretations of a 1913 study of 870 hypertensive patients (Arch, Intern. Med. 1913;12:755-98), she said. Epidemiologic studies in the 1980s and 1990s, however, found that baseline blood pressure measurements on 22,685 adults were not associated with the risk for headaches (including migraines) over the following 11 years. On the contrary--elevated blood pressures and pulse pressures were associated with a reduced risk of headaches.

Unlike chronic hypertension, acute hypertension can cause headaches in specific circumstances, the most common being pheochromocytoma, which presents with headache in up to 80% of cases as part of a complex of symptoms. Headache is rarely the only presenting symptom. The headache of pheochromocytoma may be short lasting, a thunderclap-type headache, or a unilateral throbbing pain that mimics a migraine.

A kind of recurrent, short-lasting headache has been reported to be associated with transient, paroxysmal elevations of blood pressure in patients without underlying causes of pheochromocytoma. This type of headache is thought to be caused by chronic baroreceptor failure. …