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The Hypertensive Headache: a Review

Current Pain and Headache Reports volume 23, Article number: 30 (2019) Cite this article

Abstract

Purpose of Review

The purpose of this review is to provide an overview and update on the common causes of headache attributed to arterial hypertension with a focus on secondary headache disorders. We will also highlight uncommon and recent findings in this area of research.

Recent Findings

There is some controversy in the relationship between chronic hypertension and headache, particularly migraine; recent research suggests that there may be a link, but it is likely complex and multifactorial. Many recent studies and case reports demonstrate that the pathophysiology underlying the onset of headache as it relates to abrupt rises in blood pressure seems to lie at the cellular level and mechanically becomes an issue with disruption of the blood-brain barrier. Although not a formally defined headache entity, carotid revascularization syndrome demonstrates this phenomenon and also has a recent set of proposed criteria that include headache and elevated blood pressure.

Summary

This paper reviews the various etiologies of hypertensive headaches, mostly in regard to headache as a secondary symptom of elevated blood pressure. We will also discuss trends of hypertensive headache in pregnancy. Finally, we will touch on controversy that exists in relation to chronic hypertension and its causal relationship to headache as well as the relationship between hypertension and migraine.

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References

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

  1. Headache Classification Committee of the International Headache Society (IHS) The international classification of headache disorders, 3rd edition Cephalalgia : an international journal of headache 2018;38(1):1–211. doi:https://doi.org/10.1177/0333102417738202.

  2. •• Finocchi C, Sassos D. Headache and arterial hypertension. Neurol Sci : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2017;38(Suppl 1):67–72. https://doi.org/10.1007/s10072-017-2893-x Only other narrative review on this subject in recent literature.

    Article  Google Scholar 

  3. Lagman-Bartolome AM, Gladstone J. Metabolic headaches. Neurol Clin. 2014;32(2):451–69. https://doi.org/10.1016/j.ncl.2013.11.011.

    Article  PubMed  Google Scholar 

  4. Pourian M, Mostafazadeh DB, Soltani A. Does this patient have pheochromocytoma? A systematic review of clinical signs and symptoms. J Diab Metab Disord. 2016;15(1):11. https://doi.org/10.1186/s40200-016-0230-1.

    Article  Google Scholar 

  5. Tsirlin A, Oo Y, Sharma R, Kansara A, Gliwa A, Banerji MA. Pheochromocytoma: a review. Maturitas. 2014;77(3):229–38. https://doi.org/10.1016/j.maturitas.2013.12.009.

    CAS  Article  PubMed  Google Scholar 

  6. • Han YJ, Ock SY, Kim EJ, Shin HS, Jung YS, Rim H. Thunderclap-like headache triggered by micturition and angina as an initial manifestation of bladder pheochromocytoma. A case report. Sao Paulo Med J = Revista paulista de medicina. 2015;133(2):154–9. https://doi.org/10.1590/1516-3180.2013.6890002 Important to keep these rare entities of hypertension-related thunderclap headache in mind.

    Article  PubMed  Google Scholar 

  7. Beilan JA, Lawton A, Hajdenberg J, Rosser CJ. Pheochromocytoma of the urinary bladder: a systematic review of the contemporary literature. BMC Urol. 2013;13:22. https://doi.org/10.1186/1471-2490-13-22.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Balasubramanian G, Nellaiappan V. Functional paraganglioma. BMJ case reports. 2014;2014:bcr2013203425. https://doi.org/10.1136/bcr-2013-203425.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Wuyts L, Pouillon M, Huyghe M, Ruyssers N, Goovaerts G, Spaepen M. Palpitations, headache and night sweats caused by a retroperitoneal mass: case report and short review. BJR case reports. 2017;3(4):20170035. https://doi.org/10.1259/bjrcr.20170035.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Pichler R, Heidegger I, Klinglmair G, Kroiss A, Uprimny C, Gasser RW, et al. Unrecognized paraganglioma of the urinary bladder as a cause for basilar-type migraine. Urol Int. 2014;92(4):482–7. https://doi.org/10.1159/000348829.

    Article  PubMed  Google Scholar 

  11. Berradi S, Hafidi Z, Daoudi R. Phaeochromocytoma revealed by a stellate neuroretinitis. Lancet Diab Endocrinol. 2014;2(8):676. https://doi.org/10.1016/s2213-8587(14)70129-9.

    Article  Google Scholar 

  12. • Furlan JC. Headache attributed to autonomic dysreflexia: an underrecognized clinical entity. Neurology. 2011;77(8):792–8. https://doi.org/10.1212/WNL.0b013e31822afff1 Although not recent, this is one of the most comprehensive narrative reviews of autonomic dysreflexia.

    Article  PubMed  Google Scholar 

  13. Vaidyanathan S, Soni BM, Hughes PL, Oo T. Fatal cerebral hemorrhage in a tetraplegic patient due to autonomic dysreflexia triggered by delay in emptying urinary bladder after unsuccessful intermittent catheterization by carer: lessons learned. Int Med Case Rep J. 2018;11:53–8. https://doi.org/10.2147/imcrj.s143077.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Naftchi NE, Tuckman J. Hypertensive crises in spinal man. Am Heart J. 1979;97(4):536–8.

    CAS  Article  Google Scholar 

  15. Schumacher GA, Guthrie TC. Studies on headache; mechanism of headache and observations on other effects induced by distention of bladder and rectum in subjects with spinal cord injuries. AMA Arch Neurol Psychiatr. 1951;65(5):568–80.

    CAS  Article  Google Scholar 

  16. Antonova M. Prostaglandins and prostaglandin receptor antagonism in migraine. Dan Med J. 2013;60(5):B4635.

    PubMed  Google Scholar 

  17. Krassioukov A, Warburton DE, Teasell R, Eng JJ. A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabil. 2009;90(4):682–95. https://doi.org/10.1016/j.apmr.2008.10.017.

    Article  PubMed  PubMed Central  Google Scholar 

  18. •• Kirchoff-Torres KF, Bakradze E. Cerebral Hyperperfusion Syndrome After Carotid Revascularization and Acute Ischemic Stroke. Curr Pain Headache Rep. 2018;22(4):24. https://doi.org/10.1007/s11916-018-0678-4 Recent narrative review that outlines cerebral hyperperfusion syndrome and newly proposed criteria for its diagnoses and compares this to other ICHD-3 diagnoses.

    Article  PubMed  Google Scholar 

  19. Farooq MU, Goshgarian C, Min J, Gorelick PB. Pathophysiology and management of reperfusion injury and hyperperfusion syndrome after carotid endarterectomy and carotid artery stenting. Exp Transl Stroke Med. 2016;8(1):7. https://doi.org/10.1186/s13231-016-0021-2.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Choi KS, Lee JH, Yi HJ, Chun HJ, Lee YJ, Kim DW. Incidence and risk factors of postoperative headache after endovascular coil embolization of unruptured intracranial aneurysms. Acta Neurochir. 2014;156(7):1281–7. https://doi.org/10.1007/s00701-014-2095-8.

    Article  PubMed  Google Scholar 

  21. Hwang G, Jeong EA, Sohn JH, Park H, Bang JS, Jin SC, et al. The characteristics and risk factors of headache development after the coil embolization of an unruptured aneurysm. AJNR Am J Neuroradiol. 2012;33(9):1676–8. https://doi.org/10.3174/ajnr.A3018.

    CAS  Article  PubMed  Google Scholar 

  22. Ghali MGZ, Srinivasan VM, Hanna E, DeMonte F. Overt and subclinical baroreflex dysfunction after bilateral carotid body tumor resection: pathophysiology, diagnosis, and implications for management. World Neurosurg. 2017;101:559–67. https://doi.org/10.1016/j.wneu.2017.02.073.

    Article  PubMed  Google Scholar 

  23. Milani GP, Edefonti A, Tardini G, Arturi E, Cinnante CM, Laicini EA, et al. Severe and isolated headache associated with hypertension as unique clinical presentation of posterior reversible encephalopathy syndrome. BMC Pediatr. 2014;14:190. https://doi.org/10.1186/1471-2431-14-190.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Christopoulou F, Rizos EC, Kosta P, Argyropoulou MI, Elisaf M. Does this patient have hypertensive encephalopathy. J Am Soc Hypertens : JASH. 2016;10(5):399–403. https://doi.org/10.1016/j.jash.2016.01.020.

    Article  PubMed  Google Scholar 

  25. Fischer M, Schmutzhard E. Posterior reversible encephalopathy syndrome. J Neurol. 2017;264(8):1608–16. https://doi.org/10.1007/s00415-016-8377-8.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Alrohimi A, Jassal R. Headache in Guillain-Barre syndrome: diagnostic and management implications. Can J Neurol Sci Le J: canadien des sciences neurologiques. 2018;45(2):240–2. https://doi.org/10.1017/cjn.2017.247.

    Article  Google Scholar 

  27. Raffaelli B, Siebert E, Korner J, Liman T, Reuter U, Neeb L. Characteristics and diagnoses of acute headache in pregnant women - a retrospective cross-sectional study. J Headache Pain. 2017;18(1):114. https://doi.org/10.1186/s10194-017-0823-1.

    Article  PubMed  PubMed Central  Google Scholar 

  28. • Robbins MS, Farmakidis C, Dayal AK, Lipton RB. Acute headache diagnosis in pregnant women: a hospital-based study. Neurology. 2015;85(12):1024–30. https://doi.org/10.1212/wnl.0000000000001954 Important single-center retrospective study that outlines the headache disorders experienced by pregnant women.

    Article  PubMed  PubMed Central  Google Scholar 

  29. • Robbins MS. Headache in pregnancy. Continuum (Minneapolis, Minn). 2018;24(4, Headache):1092–107. https://doi.org/10.1212/con.0000000000000642 Most recent comprehensive review of headache in pregnancy and includes the impact of hypertension during pregnancy and the comorbid risk factor of migraine during pregnancy.

    Article  Google Scholar 

  30. Crovetto F, Somigliana E, Peguero A, Figueras F. Stroke during pregnancy and pre-eclampsia. Curr Opin Obstet Gynecol. 2013;25(6):425–32. https://doi.org/10.1097/gco.0000000000000024.

    Article  PubMed  Google Scholar 

  31. Facchinetti F, Allais G, Nappi RE, D’Amico R, Marozio L, Bertozzi L, et al. Migraine is a risk factor for hypertensive disorders in pregnancy: a prospective cohort study. Cephalalgia : an international journal of headache. 2009;29(3):286–92. https://doi.org/10.1111/j.1468-2982.2008.01704.x.

    CAS  Article  Google Scholar 

  32. Sperling JD, Dahlke JD, Huber WJ, Sibai BM. The role of headache in the classification and management of hypertensive disorders in pregnancy. Obstet Gynecol. 2015;126(2):297–302. https://doi.org/10.1097/aog.0000000000000966.

    Article  PubMed  Google Scholar 

  33. Banoth P, Chaudhary K. Proteinuria: a presenting manifestation of mirror syndrome in pregnancy. Clin Nephrol. 2018;90(1):60–3. https://doi.org/10.5414/cn109299.

    Article  PubMed  Google Scholar 

  34. Shanmugalingam R, Reza Pour N, Chuah SC, Vo TM, Beran R, Hennessy A, et al. Vertebral artery dissection in hypertensive disorders of pregnancy: a case series and literature review. BMC Pregnancy and Childbirth. 2016;16(1):164. https://doi.org/10.1186/s12884-016-0953-5.

    Article  PubMed  PubMed Central  Google Scholar 

  35. •• 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. https://doi.org/10.1016/j.ajem.2014.05.017 Retrospective review examining the association and outcomes between hypertension and headache in the emergency department and the subsequent treatment of hypertension, particularly in those with known primary headache disorders (i.e., migraine). An important situation many neurologists and ED providers are faced with to determine if symptomology requires further workup or treatment.

    Article  PubMed  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. https://doi.org/10.1212/WNL.0b013e3181d0cc8b.

    CAS  Article  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. https://doi.org/10.1080/01616412.2015.1114232.

    Article  PubMed  Google Scholar 

  38. Sacco S, Ripa P, Grassi D, Pistoia F, Ornello R, Carolei A, et al. Peripheral vascular dysfunction in migraine: a review. J Headache Pain. 2013;14:80. https://doi.org/10.1186/1129-2377-14-80.

    Article  PubMed  PubMed Central  Google Scholar 

  39. • Gonzalez-Quintanilla V, Toriello M, Palacio E, Gonzalez-Gay MA, Castillo J, Montes S, et al. Systemic and cerebral endothelial dysfunction in chronic migraine. A case-control study with an active comparator. Cephalalgia : an international journal of headache. 2016;36(6):552–60. https://doi.org/10.1177/0333102415607857 Important area of both established and up and coming research into the pathophysiology of migraine.

    Article  Google Scholar 

  40. Rajan R, Khurana D, Lal V. Interictal cerebral and systemic endothelial dysfunction in patients with migraine: a case-control study. J Neurol Neurosurg Psychiatry. 2015;86(11):1253–7. https://doi.org/10.1136/jnnp-2014-309571.

    Article  PubMed  Google Scholar 

  41. • Butt JH, Franzmann U, Kruuse C. Endothelial function in migraine with aura - a systematic review. Headache. 2015;55(1):35–54. https://doi.org/10.1111/head.12494 Important area of both established and up and coming research into the pathophysiology of migraine.

    Article  PubMed  Google Scholar 

  42. Courand PY, Serraille M, Girerd N, Demarquay G, Milon H, Lantelme P, et al. The paradoxical significance of headache in hypertension. Am J Hypertens. 2016;29(9):1109–16. https://doi.org/10.1093/ajh/hpw041.

    Article  PubMed  Google Scholar 

  43. •• Chen L, Zhang Z, Chen W, Whelton PK, Appel LJ. Lower sodium intake and risk of headaches: results from the trial of nonpharmacologic interventions in the elderly. Am J Public Health. 2016;106(7):1270–5. https://doi.org/10.2105/ajph.2016.303143 Study investigating other metabolic connections to headache and hypertension: an important stepping stone for further research.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Cutrer FM. Pathophysiology of migraine. Semin Neurol. 2010;30(2):120–30. https://doi.org/10.1055/s-0030-1249222.

    Article  PubMed  Google Scholar 

  45. Arca KN, Halker Singh RB. SUNCT and SUNA: an update and review. Curr Pain Headache Rep. 2018;22(8):56. https://doi.org/10.1007/s11916-018-0707-3.

    Article  PubMed  Google Scholar 

  46. Matei D, Constantinescu V, Corciova C, Ignat B, Matei R, Popescu CD. Autonomic impairment in patients with migraine. Eur Rev Med Pharmacol Sci. 2015;19(20):3922–7.

    CAS  PubMed  Google Scholar 

  47. • Miglis MG. Migraine and autonomic dysfunction: which is the horse and which is the jockey? Curr Pain Headache Rep. 2018;22(3):19. https://doi.org/10.1007/s11916-018-0671-y Another area of research that may help establish the pathophysiologic link between migraine and hypertension and other blood pressure changes.

    Article  PubMed  Google Scholar 

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  1. Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA

    Karissa N. Arca & Rashmi B. Halker Singh

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Arca, K.N., Halker Singh, R.B. The Hypertensive Headache: a Review. Curr Pain Headache Rep 23, 30 (2019). https://doi.org/10.1007/s11916-019-0767-z

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Keywords

  • Secondary headache
  • Headache
  • Hypertension
  • Blood pressure
  • Arterial
  • Autoregulation