Migraine Treatment When Cardiovascular Disease Is Present
Unfortunately, any migraine treatment that decreases the width of a blood vessel, even very temporarily, cannot be used in those who have or might have cardiovascular disease. In those who are at increased risk by uncontrolled blood pressure, high cholesterol, or several risk factors, such as smoking, diabetes, obesity, and heredity, these risk factors need to be treated and consideration be given to cardiac testing, such as exercise treadmill or nuclear stress test. It is estimated that triptans , as well as DHE, can narrow heart blood vessels by 18%. While this is a minor narrowing for a person with normal heart vessels, in those with cholesterol build up, it can become significant.
All non-steroidal anti-inflammatory drugs , such as ibuprofen, diclofenac, and naproxen, now carry a black box label from the US Food and Drug Administration because of their association with increased risk of heart attack. NSAIDs do vary in the amount of risk to the heart, with naproxen the safest. Other NSAIDs vary in their heart risk, mostly seen in those who use them frequently. Using NSAIDs not more than 2 days a week is generally safe in most individuals who have never had a heart attack. Other acute, as-needed medications that may help dial down the migraine pain without causing blood vessel narrowing include metoclopramide, prochloperazine, diphenhydramine, baclofen, acetaminophen, and gabapentin. Trigger point injections and nerve blocks may also be used.
Deborah Tepper, MD
High Blood Pressure Crisis And Headache
High blood pressure crisis is known as hypertensive crisis. This is typically defined as blood pressure greater than 180 systolic and 120 diastolic . This is typically a severe uncontrolled episode in patients that usually have a history of blood pressure. Many symptoms can be experienced with the presentation of a hypertensive crisis and typically patients will present to hospital. Headache is one of these symptoms, with others including neurological issues and chest pain. If there is evidence of damage to organs such as the heart, brain or kidney, patients will typically require admission to an intensive care unit and IV medications to control blood pressure.
Can High Blood Pressure Cause Migraine Or Can Migraine Cause High Blood Pressure
Raised blood pressure doesn’t usually cause any symptoms, but a hypertensive crisis acute dangerously high blood pressure can have significant symptoms.
Some people do get migraines with high blood pressure, but the link between the two is quite complex. Migraines and high blood pressure can each have the same cause.
A person is more likely to have a migraine or high blood pressure when they are ill, stressed, depressed, reacting to food intolerances, doing sudden strenuous exercise, or for lots of other reasons.
This means that migraine and high blood pressure may sometimes happen at the same time because they have the same underlying cause.
Blood pressure can be raised when someone is unwell, under stress, or for lots of other reasons, so someone suffering from a migraine an acute episode of pain and other unpleasant symptoms might have elevated blood pressure as a result.
People who report having the kind of migraine that comes with an ‘aura’ people often describe flashing lights and similar symptoms before a migraine are at a slightly increased risk of cardiovascular disease.
The mechanisms of this link aren’t fully understood, but it does mean that people who suffer from migraines should be aware of their risk of cardiovascular disease and manage their other risk factors as well as they can.
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Diagnosing And Treating Ocular Migraines
When you visit your doctor, they will ask about your symptoms, examine your eyes, and order additional tests to rule out other serious conditions such as:
- Amaurosis fugax
- Giant cell arteritis
- Spasms in the blood vessels that carry blood to the eye
- Autoimmune diseases
- Stroke or transient ischemic attack
- Drug abuse
Professional Treatments
If you have been diagnosed with retinal migraines, consult your doctor about the best treatment options. There is no one recommended treatment regimen since it varies from person to person.
If you dont experience ocular migraines very frequently, your doctor may advise you to use over-the-counter NSAIDs like aspirin and ibuprofen when the episodes occur.4
Your doctor may also recommend the following:
- Anti-nausea medication to reduce nausea and related symptoms
- Calcium channel blockers to lower blood pressure
- Anti-epileptic medications to prevent seizures
- Tricyclic antidepressants to alter the brains chemistry
Doctors dont usually use traditional migraine treatments such as triptans and ergotamines for people with ocular migraines.5
Triptans, for example, arent safe if youre at risk for a stroke, which may be the case for people experiencing temporary blindness in one eye.
A recent technique for treating or preventing ocular migraine is to use a self-administered device that delivers electrical stimulation to the forehead or back of the head. These devices include:
Home Remedies
Blood Pressure: How High Is Too High
Systolic blood pressure is the upper number in a blood pressure measurement. It refers to how much pressure your blood is exerting against your artery walls when your heart beats. The lower number, diastolic pressure, refers to how much pressure your blood is exerting against your artery walls when your heart is resting between beats. A blood pressure of less than 120/80 mm Hg is considered normal.
Nearly half of adults in the U.S. have high blood pressuremeaning greater than 130/80 mm Hgaccording to the American Heart Association . When untreated, high blood pressure increases the risk for heart attack, stroke, and other complications by damaging blood vessels throughout your body.
In most cases, high blood pressure does not cause headaches, nosebleeds, or any other symptoms, stresses Salim Virani, MD, professor, sections of cardiology and cardiovascular research, Baylor College of Medicine, Houston.
If you are waiting for symptoms to tell you that you have high blood pressure, you have missed the boat, he says. Waiting for symptoms is actually a very big mistake. We need to pick up high blood pressure in the absence of symptoms. This gives doctors the best opportunity to treat high blood pressure and avoid complications.
If you have high blood pressure, you have to take your medicine every day, even if you feel fine. Dont wait for symptoms to take your medication, says Dr. Virani.
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Making Your Blood Pressure Treatment Work For You
One thing is certain: your blood pressure treatment program will work best if you follow it. Where can you get the support, education, reminders, and tracking you may need to get active, lose weight, take your medications, and choose healthier foods?
Lark Hypertension Care is a health coach that is ready for you 24/7. This smartphone app is designed for hypertension management through a program customized for you, with positive hypertension outcomes for Lark users. You can use it to lower your blood pressure and maybe, just maybe, high blood pressure headaches will not happen to you!
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Is There A Correlation Between Migraines And Hypertension
A recent study conducted by epidemiologists at the United States National Heart, Lung, and Blood Institute indicates that Hispanic Americans have a high risk of suffering from complications related to high blood pressure conditions left untreated. This large scale study, which evaluated more than 16,000 Hispanic Americans between the ages of 18 and 74, revealed that less than 40 percent of Latinos undergo treatment for high blood pressure.
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How Do Hypertension Migraines Affect Most People
The pain from hypertension migraines can range from fairly mild to extremely severe, depending on how high the patients blood pressure is when the headache begins. Some people may also experience nausea, vomiting, double vision, throbbing noise within the ears and obscured vision.
Since severely elevated blood pressure may result in serious complications, including hypertensive encephalopathy, its important to see a doctor quickly if youre dealing with new severe headaches. A quality headache specialist can help diagnose your type of migraine and come up with the treatment option that will best meet your needs. Give us a call today to schedule your appointment.
Treatment For High Blood Pressure Headaches
If you do get them, high blood pressure headaches tend to come during a hypertensive crisis. This is defined as blood pressure over 180/120 mm Hg. You might also have a nosebleed or feel generally ill.
The American Heart Association and American College of Cardiology recommend these steps if you have a hypertension headache due to a hypertensive crisis.
- Take your blood pressure if you suspect you have a hypertensive crisis.
- If it is over 180/120 mm Hg, rest for 5 minutes.
- Take your blood pressure again.
- If you still have a headache or nosebleed or do not feel well and your blood pressure is still over 180/120 mm Hg, dial 9-1-1.
Without quick action to lower your blood pressure, a hypertensive crisis can lead to permanent target organ damage, such as to your brain, heart, and kidneys.
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Research On The Link Between Migraine And High Blood Pressure
Women are three times more likely than men to have migraine, according to the Migraine Research Foundation, and for this reason, much of the research on the link between hypertension and migraine has been conducted on women.
According to Dr. Rist, its difficult to untangle the two conditions, and to do so, we need to look at it from so many different angles. It appears that there is a genetic trait linked with both, but some believe its a causal relationship, meaning that either migraine causes high blood pressure or vice versa.
In a study examining the potential causal relationship, published in February 2018 in the journal Cephalalgia, researchers followed nearly 30,000 women for 12 years. They found that, overall, women who had a history of any type of migraine were more likely to have high blood pressure than women who did not have a history of migraine.
In addition, some types of migraine appeared to be correlated with higher rates of hypertension than others. Compared with women with no history of migraine, those who had a history of migraine without aura had a 21 percent increased risk of hypertension twice that of women who had migraine with aura, whose risk was elevated by roughly 10 percent.
A study looking for a genetic explanation, Nature Communications, identified 12 genes that appeared to have an impact on both blood pressure and susceptibility to migraine.
What Questions Should I Ask My Healthcare Provider
- Will my child grow out of their migraines?
- What medications do you recommend for me?
- What should I change about my lifestyle to prevent my migraine headaches?
- Should I get tested?
- What type of migraine do I have?
- What can my friends and family do to help?
- Are my migraines considered chronic?
A note from Cleveland Clinic
Migraine headaches can be devastating and make it impossible to go to work, school or experience other daily activities. Fortunately, there are some ways to possibly prevent a migraine and other ways to help you manage and endure the symptoms. Work with your healthcare provider to keep migraines from ruling your life.
Last reviewed by a Cleveland Clinic medical professional on 03/03/2021.
References
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Understanding High Blood Pressure Headaches
If you are one of the millions of people who live with high blood pressure, you were probably surprised when your doctor told you that your numbers were higher than they should beespecially because you feel fine.
High blood pressure doesnt typically cause symptoms. However, some people may have headachesespecially if their blood pressure skyrockets into the danger zonea condition known as high blood pressure emergency or urgency.
Heres what you need to know about a high blood pressure headache, what other symptoms may occur, and when to call 911.
What Type Of Doctor Do You See For Ocular Migraines
If you have ocular migraines, you can see an ophthalmologist oran optometrist.
Optometrists are eye care specialists who offer primary vision care services, including:
- Vision testing
- Correction of visual problems
- Treatment and management of visual issues and eye diseases
On the other hand, ophthalmologists are medical practitioners who specialize in eye and vision care. They differ from optometrists in their degrees of schooling as well as what they can diagnose and cure.
An ophthalmologist is a healthcare professional who has finished college and has at least eight years of further medical studies. He or she is licensed to practice medicine and surgery. Ophthalmologists hold a Doctor of Medicine degree.
Optometrists are healthcare professionals who complete four additional years of school after finishing undergraduate studies. They hold a Doctor of Optometry degree.
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What Can Trigger A Hypertension Migraine
High blood pressure is the trigger behind a hypertension migraine, and usually, blood pressure has to be around 200/100 or higher to result in these types of headaches. When blood pressure is this high, it qualifies as a medical emergency, and immediate medical attention is needed. Autoregulation, a process of the body that works to figure out and control blood supply, results in the blood vessels in the skull constricting, which can cause the extreme pain of the headache.
High Blood Pressure And Headaches At The Same Time Without One Causing The Other
There have been numerous other studies trying to find links between other types of headaches and high blood pressures. However, none of them have consistently proven direct links. Here are some interesting findings about the relationship between high blood pressure and migraine headaches.
A study comparing high blood pressure patients with headaches and high blood pressure patients without headaches
Some patients with high blood pressure have headaches and others dont. This study wanted to see if having both high blood pressure and headaches is worse than high blood pressure without headaches. They wanted to see if perhaps headaches associated with high blood pressure meant that those high blood pressure patients had a worse kind of high blood pressure. This study was published in the American Journal of Hypertension in 2016. They followed 1,914 patients for 30 years. They initially marked them as having high blood pressure with headaches and high blood pressure without headaches. At the end of the 30 years, they tracked those patients and found out that 580 of them died from a heart attack and 97 of them died from a stroke.
A study comparing the blood pressures of patients visiting the emergency department with headaches to the blood pressures of patients visiting the emergency department without headaches
A study comparing the association between high blood pressure and migraine headaches in patients visiting the ER in northern Manhattan
References:
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Understanding Hypertension Migraines And Their Triggers
Hypertension is another term for high blood pressure, and this takes place when the blood flow force inside the arteries becomes elevated. In many cases, hypertension goes undiagnosed because it doesnt cause symptoms, which is why its often known as a silent killer. Just a few of the symptoms and problems it may cause include dizziness, stroke, heart disease, heart attack and even headaches. When some peoples blood pressure is extremely high, they deal with a headache sometimes called a hypertension migraine.
What Does An Ocular Migraine Feel Like
An ocular migraine begins with a sparkling and shimmering area that has a jagged border and that gradually spreads outward. It causes a small blinding spot that enlarges and blocks your vision temporarily. The brightness begins at the edge of your field of vision and gradually spreads to your line of vision. Zigzag lines or stars may also be seen. It is almost like looking through a broken window. Scotoma is the area where vision is disrupted and the whole episode is called a positive aura.
An ocular migraine is often referred to differently by different experts. While many call it a visual migraine or a typical aura without headache, the International Headache Society classifies such a migraine as a silent or acephalgic migraine.
Though it seems serious since you lose your vision partially, the condition is usually harmless and will resolve on its own within 2030 minutes without any medical intervention. Complete visual darkness, or a negative aura, is not a symptom of an ocular migraine, but of some other underlying condition that needs to be investigated.2
Apart from visual disturbances, ocular migraines can also interfere with your speech. You may also feel tingling, weakness, or numbness in your hands and legs, experience size or space distortions, or feel confused. All of these, however, are rare.3
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What Are The Symptoms Of Hypertension Headache
Headaches associated with Hypertension are often describes as pulsating and throbbing and will often occur in the morning. However, it has been reported that hypertension can cause classic symptoms of Tension-Type Headache and Migraine .
| Symptoms of Hypertension | Potential Symptoms of Hypertension headache |
| Headaches | Pulsating, throbbing early morning headache |
| Shortness of breath | |
| Chest pain |
The More We Know About The Relationship Between High Blood Pressure And Migraines The More We Will Be Able To Understand And Treat Them
Lets explore this connection and how it might impact your life in a serious way!
HBP, or hypertension, is when your systolic and diastolic blood pressures readings are consistently above the levels your doctor considers healthy
HBP can be caused by several factors, including genetics, age, family health history, lack of exercise, and poor diet. It can also be influenced by other conditions like diabetes or kidney issues. High BP is not considered a diseasein itself rather its typically seen as a classic risk factor for many other conditions
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