By: Thomas Pickering, MD, DPhil, FRCP, Director of Integrative and Behavioral Cardiology Program
of the Cardiovascular Institute at Mount Sinai School of Medicine, New York.

Headache is generally regarded as being a symptom of high blood pressure, although it is also stated that hypertension is the “silent killer”. Many people who have high blood pressure think that when they get a headache it means that their pressure has gone up. The problem here is that both headache and high blood pressure are very common, which means that it is certainly true that the two occur together, but what exactly is the connection?

A study conducted in Poland has provided some interesting answers. One hundred and fifty patients, most of who were taking blood pressure-lowering medications, and who were referred to a hypertension clinic for evaluation, wore a 24-hour ambulatory blood pressure monitor. These monitors take a blood pressure reading every 20 minutes during the day, and 30 minutes during the night. The patients were asked to record in a diary whenever they had a headache, and in fact during the 24-hour monitoring period 43 of the patients (about one third) reported a headache, which lasted an average duration of 3 hours. In general, there was no connection between the occurrence of headaches and what was happening to the blood pressure, and in most cases the highest readings of blood pressure were not associated with headaches. In addition, there was no particular tendency for the blood pressure to go up or down just before the headache started. Whether or not the patients were taking blood pressure lowering medications also had no effect on the association between headache and blood pressure.

Doctor’s comments

Most of us, whatever our blood pressure levels, get headaches from time to time, and the relationships between blood pressure and headache have always been a bit uncertain. It is true that in a small number of patients with very high blood pressure, headache can occur as a consequence, but this is probably rare. One study actually found that headaches were more likely to occur after people had been diagnosed with high blood pressure, which may have been because of the anxiety associated with the awareness of high blood pressure, rather than because of the blood pressure itself. The clear finding of this study is that most of the headaches in people with high blood pressure, whether treated or not, do not occur because the blood pressure has gone up

There is some evidence from other studies that people with hypertension are more likely to have migraine headaches, and also some reports that some of the blood pressure lowering drugs such as calcium channel blockers and beta-blockers are effective for treating these. Again, this may not necessarily a result of a lower blood pressure. The message here is that if you have hypertension and are getting headaches, it does not mean that your blood pressure out of control, and that the best treatment for the headache may be the traditional pain killers such as aspirin.

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