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Headache Disorders: Does Pain Affect Blood Pressure?

  • Hot Topics in Pain and Headache (N Rosen, Section Editor)
  • Published:
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Abstract

Purpose of Review

The perspective that pain corresponds to elevated blood pressure is overly simplistic. Our objective is to investigate and debunk misconceptions regarding the effect of pain on blood pressure.

Recent Findings

While pain can increase blood pressure in the acute setting, prolonged pain and migraine’s effect on blood pressure varies and can result in lower-than-expected blood pressure. Therefore, attributing pain as a sole source of elevation of blood pressure may lead to delays in diagnosing hypertension. Based on limited studies available, comorbid pain and chronic hypertension have a higher concurrence than in the general population.

Summary

We will review current literature to investigate the effect of pain on blood pressure and prevalence of hypertension in chronic pain sufferers. 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.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Bruehl S, Chung OY, Jirjis JN, Biridepalli S. Prevalence of clinical hypertension in patients with chronic pain compared to nonpain general medical patients. Clin J Pain. 2005;21(2):147–53.

    Article  PubMed  Google Scholar 

  2. Loder E. What is the evolutionary advantage of migraine? Cephalalgia. 2002;22(8):624–32.

    Article  CAS  PubMed  Google Scholar 

  3. • Saccò M, Meschi M, Regolisti G, Detrenis S, Bianchi L, Bertorelli M, et al. The relationship between blood pressure and pain. J Clin Hypertens (Greenwich). 2013;15(8):600–5. This article explores the pathophysiology between acute and chronic pain and blood pressure.

    Article  Google Scholar 

  4. Fagius J, Karhuvaara S, Sundlöf G. The cold pressor test: effects on sympathetic nerve activity in human muscle and skin nerve fascicles. Acta Physiol Scand. 1989;137(3):325–34.

    Article  CAS  PubMed  Google Scholar 

  5. Nordin M, Fagius J. Effect of noxious stimulation on sympathetic vasoconstrictor outflow to human muscles. J Physiol. 1995;489 ( Pt 3)(Pt 3):885–94.

  6. Fazalbhoy A, Birznieks I, Macefield VG. Individual differences in the cardiovascular responses to tonic muscle pain: parallel increases or decreases in muscle sympathetic nerve activity, blood pressure and heart rate. Exp Physiol. 2012;97(10):1084–92.

    Article  PubMed  Google Scholar 

  7. Sato A, Sato Y, Schmidt RF. Changes in blood pressure and heart rate induced by movements of normal and inflamed knee joints. Neurosci Lett. 1984;52(1–2):55–60.

    Article  CAS  PubMed  Google Scholar 

  8. Maixner W, Gracely RH, Zuniga JR, Humphrey CB, Bloodworth GR. Cardiovascular and sensory responses to forearm ischemia and dynamic hand exercise. Am J Physiol. 1990;259(6 Pt 2):R1156–63.

    CAS  PubMed  Google Scholar 

  9. Cirillo M, Stellato D, Lombardi C, De Santo NG, Covelli V. Headache and cardiovascular risk factors: positive association with hypertension. Headache. 1999;39(6):409–16.

    Article  CAS  PubMed  Google Scholar 

  10. Gudmundsson LS, Thorgeirsson G, Sigfusson N, Sigvaldason H, Johannsson M. Migraine patients have lower systolic but higher diastolic blood pressure compared with controls in a population-based study of 21,537 subjects. The Reykjavik Study Cephalalgia. 2006;26(4):436–44.

    Article  CAS  PubMed  Google Scholar 

  11. Franceschi M, Colombo B, Rossi P, Canal N. Headache in a population-based elderly cohort. An ancillary study to the Italian Longitudinal Study of Aging (ILSA). Headache. 1997;37(2):79–82.

  12. Hagen K, Stovner LJ, Vatten L, Holmen J, Zwart JA, Bovim G. Blood pressure and risk of headache: a prospective study of 22 685 adults in Norway. J Neurol Neurosurg Psychiatry. 2002;72(4):463–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Rasmussen BK, Olesen J. Symptomatic and nonsymptomatic headaches in a general population. Neurology. 1992;42(6):1225–31.

    Article  CAS  PubMed  Google Scholar 

  14. Juhasz G, Zsombok T, Modos EA, Olajos S, Jakab B, Nemeth J, et al. NO-induced migraine attack: strong increase in plasma calcitonin gene-related peptide (CGRP) concentration and negative correlation with platelet serotonin release. Pain. 2003;106(3):461–70.

    Article  CAS  PubMed  Google Scholar 

  15. Uzar E, Evliyaoglu O, Yucel Y, Ugur Cevik M, Acar A, Guzel I, et al. Serum cytokine and pro-brain natriuretic peptide (BNP) levels in patients with migraine. Eur Rev Med Pharmacol Sci. 2011;15(10):1111–6.

    CAS  PubMed  Google Scholar 

  16. Juhasz G, Zsombok T, Laszik A, Jakus R, Faludi G, Sotonyi P, et al. Despite the general correlation of the serotonin transporter gene regulatory region polymorphism (5-HTTLPR) and platelet serotonin concentration, lower platelet serotonin concentration in migraine patients is independent of the 5-HTTLPR variants. Neurosci Lett. 2003;350(1):56–60.

    Article  CAS  PubMed  Google Scholar 

  17. Halker RB, Starling AJ, Vargas BB, Schwedt TJ. ACE and ARB agents in the prophylactic therapy of migraine-how effective are they? Curr Treat Options Neurol. 2016;18(4):15.

    Article  PubMed  Google Scholar 

  18. • Bruehl S, Olsen RB, Tronstad C, Sevre K, Burns JW, Schirmer H, et al. Chronic pain-related changes in cardiovascular regulation and impact on comorbid hypertension in a general population: the Tromsø study. Pain. 2018;159(1):119–27. This paper provides a potential etiology behind the increased prevalence of high blood pressure in chronic pain sufferers.

    Article  PubMed  Google Scholar 

  19. Pickering TG, James GD, Boddie C, Harshfield GA, Blank S, Laragh JH. How common is white coat hypertension? JAMA. 1988;259(2):225–8.

    Article  CAS  PubMed  Google Scholar 

  20. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension global hypertension practice guidelines. J Hypertens. 2020;38(6):982–1004.

    Article  CAS  PubMed  Google Scholar 

  21. Poon SJ, Roumie CL, O'Shea CJ, Fabbri D, R. Coco J, Collins SP, et al. Association of elevated blood pressure in the emergency department with chronically elevated blood pressure. J Am Heart Assoc. 2020;9(12):e015985.

  22. Tanabe P, Persell SD, Adams JG, McCormick JC, Martinovich Z, Baker DW. Increased blood pressure in the emergency department: pain, anxiety, or undiagnosed hypertension? Ann Emerg Med. 2008;51(3):221–9.

    Article  PubMed  Google Scholar 

  23. Pfoh ER, Chaitoff AM, Martinez K, Keenan K, Rothberg MB. Association between pain, blood pressure, and medication intensification in primary care: an observational study. J Gen Intern Med. 2020;35(12):3549–55.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Seçil Y, Unde C, Beckmann YY, Bozkaya YT, Ozerkan F, Başoğlu M. Blood pressure changes in migraine patients before, during and after migraine attacks. Pain Pract. 2010;10(3):222–7.

    Article  PubMed  Google Scholar 

  25. Friedman BW, Mistry B, West JR, Wollowitz A. The association between headache and elevated blood pressure among patients presenting to an ED. Am J Emerg Med. 2014;32(9):976–81.

  26. Morrison A, Ramey DR, van Adelsberg J, Watson DJ. Systematic review of trials of the effect of continued use of oral non-selective NSAIDs on blood pressure and hypertension. Curr Med Res Opin. 2007;23(10):2395–404.

    Article  CAS  PubMed  Google Scholar 

  27. Caughey GE, Cleland LG, Penglis PS, Gamble JR, James MJ. Roles of cyclooxygenase (COX)-1 and COX-2 in prostanoid production by human endothelial cells: selective up-regulation of prostacyclin synthesis by COX-2. J Immunol. 2001;167(5):2831–8.

    Article  CAS  PubMed  Google Scholar 

  28. Jhee SS, Salazar DE, Ford NF, Fulmor IE, Sramek JJ, Cutler NR. A double-blind, randomized, crossover assessment of blood pressure following administration of avitriptan, sumatriptan, or placebo to patients with mild to moderate hypertension. Cephalalgia. 1999;19(2):95–9.

    Article  CAS  PubMed  Google Scholar 

  29. Vanmolkot FH, de Hoon JN. Acute effects of sumatriptan on aortic blood pressure, stiffness, and pressure waveform. Clin Pharmacol Ther. 2006;80(1):85–94.

    Article  CAS  PubMed  Google Scholar 

  30. Krantz MJ, Palmer RB, Haigney MCP. Cardiovascular complications of opioid use: JACC state-of-the-art review. J Am Coll Cardiol. 2021;77(2):205–23.

    Article  CAS  PubMed  Google Scholar 

  31. Hamam MS, Kunjummen E, Hussain MS, Nasereldin M, Bennett S, Miller J. Anxiety, depression, and pain: considerations in the treatment of patients with uncontrolled hypertension. Curr Hypertens Rep. 2020;22(12):106.

    Article  PubMed  Google Scholar 

  32. Al-Ghamdi S, Shubair MM, El-Metwally A, Alsalamah M, Alshahrani SM, Al-Khateeb BF, et al. The relationship between chronic pain, prehypertension, and hypertension. A population-based cross-sectional survey in Al-Kharj, Saudi Arabia. Postgrad Med. 2021;133(3):345–50.

  33. • Giummarra MJ, Tardif H, Blanchard M, Tonkin A, Arnold CA. Hypertension prevalence in patients attending tertiary pain management services, a registry-based Australian cohort study. PLoS ONE. 2020;15(1): e0228173. This is a large study that revealed hypertension is more common in patients with chronic pain than in the general community.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Kurth T, Winter AC, Eliassen AH, Dushkes R, Mukamal KJ, Rimm EB, et al. Migraine and risk of cardiovascular disease in women: prospective cohort study. BMJ. 2016;353: i2610.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Rist PM, Winter AC, Buring JE, Sesso HD, Kurth T. Migraine and the risk of incident hypertension among women. Cephalalgia. 2018;38(12):1817–24.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Bigal ME, Kurth T, Santanello N, Buse D, Golden W, Robbins M, et al. Migraine and cardiovascular disease: a population-based study. Neurology. 2010;74(8):628–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Kandil MR, Hamed SA, Fadel KA, Khalifa HE, Ghanem MK, Mohamed KO. Migraine in Assiut Governorate, Egypt: epidemiology, risk factors, comorbid conditions and predictors of change from episodic to chronic migraine. Neurol Res. 2016;38(3):232–41.

    Article  PubMed  Google Scholar 

  38. Arca KN, Halker Singh RB. The hypertensive headache: a review. Curr Pain Headache Rep. 2019;23(5):30.

    Article  PubMed  Google Scholar 

  39. Vij B, Whipple MO, Tepper SJ, Mohabbat AB, Stillman M, Vincent A. Frequency of migraine headaches in patients with fibromyalgia. Headache. 2015;55(6):860–5.

    Article  PubMed  Google Scholar 

  40. Tseng CH, Chen JH, Wang YC, Lin MC, Kao CH. Increased risk of stroke in patients with fibromyalgia: a population-based cohort study. Medicine (Baltimore). 2016;95(8): e2860.

    Article  CAS  Google Scholar 

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Correspondence to Sweta Sengupta.

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Sweta Sengupta, M.D., and Timothy Collins, M.D., declare no conflict of interest.

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Sengupta, S., Collins, T. Headache Disorders: Does Pain Affect Blood Pressure?. Curr Pain Headache Rep 26, 821–826 (2022). https://doi.org/10.1007/s11916-022-01083-1

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