Hypertension Headache: Medical Myth or True Health Concern?

When hypertension can lead to an emergency

Sudden headaches are possible in cases of hypertensive emergencies, which generally occur when the patient’s underlying hypertension has accelerated and there is risk of end organ damage. This is typically characterized by microvascular damage, which is an injury to the very small arteries in one or more of the vital organs, such as your heart, brain, kidneys or eyes.  For many patients, this occurs when they have stopped following a regimen for controlling high blood pressure. In this scenario, a severely high blood pressure of 180/120 or above could be coupled with additional symptoms such as blurred vision, nausea or vomiting, change in mental status, chest pain, numbness and cough.  

 ”An emergency would be a very high level of blood pressure that is associated with active progression of end organ damage,” Whelton says. In those situations, the medical team would be looking for eye hemorrhages and other signs, such as nausea or blurred vision, that there’s active organ damage occurring.

“It’s when your body is telling you that this level of blood pressure is causing a problem, that’s when you get concerned and ... bring somebody into the ER,” Whelton adds. 

In these emergency situations, the doctors would try to lower blood pressure immediately with oral medication, or intravenously in a setting where people can be carefully monitored, such as the emergency department, to ensure that blood pressure does not go too low.

People should not try to lower their blood pressure at home during a hypertensive emergency, Whelton warns, even if they have medications on hand. Reducing your blood pressure too rapidly could affect the blood flow to the brain and cause unwanted and potentially dangerous side effects.

Uncontrolled Hypertension  

A more typical situation is uncontrolled hypertension, which has also been called hypertension urgency. This can occur when people have blood pressure of 180/120 or higher but are showing no other symptoms of ongoing organ damage.  “[In that situation] we do not bring down the blood pressure immediately because it’s more dangerous than it is beneficial,” Whelton says.  

Uncontrolled hypertension often occurs when people who have been prescribed blood pressure medicine do not take it or stop taking it for some time. Doctors will reinstitute the medication and try to address whatever the impediment is for the person to take their medication, including costs, accessibility, side effects or inconvenience. ​​While this situation may not be an emergency, it’s still very important to contact your doctor or other medical provider if you have concerns about your blood pressure numbers. Unusual or sudden headaches should also be addressed with your medical professional. 

Other headache causes related to high blood pressure

Aneurysm

Severe head pain is also a symptom of someone experiencing a ruptured brain aneurysm. A brain aneurysm is a ballooning blood vessel in the brain and can be common and nonharmful, unless it ruptures. However, when aneurysms rupture, “It just hits you like a hammer…. People generally describe it as the most severe headaches I’ve ever had. It’s often associated with nausea and vomiting,” Whelton says.  

Ischemic stroke 

An ischemic stroke is caused by a blockage in an artery that is either in the brain or that brings blood to the brain, such as a carotid artery, in your neck.  Lack of blood flow to the brain can result in a stroke, especially if there is a complete blockage in the artery. The blockage can result from a buildup of cholesterol (called plaque) or from a clot that may have formed elsewhere in the body and passed into an artery. Hypertension increases the risk for ischemic stroke.

High blood pressure is a primary cause for hemorrhagic stroke, where a blood vessel in the brain ruptures and blood spills into the brain or the sac that surrounds the brain. About 13 percent of strokes are hemorrhagic; the remainder are ischemic.  “So when that rupture occurs and that blood gets out, boy, are you going to have a headache,” Whelton says. Other symptoms could include drooping muscles on one or both sides of the face; weakness in one arm, leg or side of the body; and dizziness. Lowering blood pressure is the best way to prevent a first stroke and subsequent strokes, he adds.

These are considered emergency situations and 911 should be called immediately.​

Sarah Rogers (Source: Getty Images(2))

Where did the high blood pressure headache myth begin? 

The hypertension headache myth could have started with the death of President Franklin Delano Roosevelt in 1945. After dealing with numerous health challenges, including high blood pressure, Roosevelt uttered the famous last words, “I have a terrific pain in the back of my head.” His cause of death was cited as a cerebral hemorrhage, or bleeding within the brain, which is commonly caused by elevated blood pressure. 

“At that time, we didn’t really have treatment for [high blood pressure] like we do now,” says Green. We don’t see these types of emergency-related headaches very often today because more people regularly monitor their blood pressure and take medication, she added.

Following Roosevelt’s death, on June 16, 1948, President Harry Truman signed into law the National Heart Act, which allocated funding for a 20-year epidemiologic heart study, which became the Framingham Heart Study. He also established the National Heart Institute, now known as the National Heart, Lung and Blood Institute, part of the National Institutes of Health.