Migraine and hypertension: What is the link?

Can migraine cause high blood pressure? 

Medical experts have long debated whether migraine causes hypertension or vice versa.

Several studies have found a connection between the two conditions, but researchers need to further explore the possible links.

What the research says

One 2018 study involving women ages 45 years and older found that those with a history of migraine had a 15% higher chance of developing high blood pressure than those with no history of migraine.

The researchers have several hypotheses for why migraine may cause high blood pressure:

• A person may have the genes that cause both conditions.
• Factors in the body that cause migraine may also trigger high blood pressure.
• Enzymes in the body that regulate blood pressure may also play a role in causing migraine.
• Repetitive pain from migraine may lead to high blood pressure.

In a 2021 study looking at the link between high blood pressure and migraine, the authors concluded that people with migraine had a higher risk of developing high blood pressure. They also clarified that more research is necessary to determine the exact link between the two conditions.

Another study from 2021 looked at whether women with a history of migraine were at a higher risk for high blood pressure after menopause. The researchers found that women in menopause who had migraine were more likely to have high blood pressure.

What happens to blood pressure during a migraine?

It is common knowledge among doctors that a person’s blood pressure may increase in response to acute pain.

However, people who experience migraine often do not show changes in their blood pressure. These findings suggest that the relationship between migraine and blood pressure varies among individuals.

What does a migraine feel like if a person’s blood pressure increases?

According to the Centers for Disease Control and Prevention (CDC), high blood pressure does not typically cause any symptoms. Many people with high blood pressure do not know they have it. The same goes for people who have high blood pressure with migraine.

A migraine headache usually causes mild to severe pain on both sides of the head. There are many types of migraine headaches. Depending on the type, a person may also experience other symptoms, such as:

• neck pain
• sensitivity to light and sound
• nausea
• brain fog
• phantom smells
• dizziness
• mood changes

Vs. hypertension migraine

High blood pressure typically has no symptoms. However, if a person experiences a hypertensive crisis — a blood pressure of 180/120 millimeters of mercury or greater — they may have the following symptoms:

• headache
• dizziness
• altered mental status
• vomiting
• changes in vision
• chest pain
• shortness of breath

This condition is a medical emergency that requires swift treatment to rapidly lower the blood pressure.

Hypertensive crisis most commonly occurs in people who have a history of hypertension and do not take their medications as their doctor prescribes. This can cause their blood pressure to rise to a dangerous level.

Diagnosis

Doctors can use various tests and tools to diagnose migraine and high blood pressure.

Migraine scans

Medical professionals may order a CT scan or MRI scan to look at the structures in the head and neck.

Migraine assessment

To diagnose migraine, a doctor will ask a person questions about the following:

• their medical and family history
• any medications they take for conditions other than headaches
• their allergies
• any mental health conditions they have
• any sleep difficulties they have
• their smoking status
• their levels of alcohol and caffeine consumption

It can be helpful to keep a migraine journal to track:

• possible triggers, such as anything that may have happened on the day of a migraine episode
• pain characteristics, such as timing, frequency, and severity
• use of medications

Testing blood pressure at different intervals

To diagnose high blood pressure, a doctor will check a person’s blood pressure at several different times. They may ask the person to sit, stand, or lie down during the test.

The doctor may also ask the person to come in at different times to check their blood pressure when they have not had caffeine or exercised within the last 30 minutes.

Once the doctor confirms the diagnosis, they may order tests to determine the cause of the high blood pressure.

Treatment

Migraine currently has no cure. However, with a combination of medications and lifestyle strategies, many people can manage the condition. It is especially important for a person to identify and avoid their migraine triggers.

Medications

Prescription medications that doctors may prescribe for migraine include triptans, antiemetics, and ergotamines.

Several over-the-counter medications may also help a person manage mild migraine headaches, including:

• acetaminophen (Tylenol)
• aspirin
• nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil)

The doctor may also order prescription medications such as the following to help keep a person’s blood pressure in a healthy range:

• angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers to keep blood vessels from narrowing
• calcium channel blockers to prevent calcium from entering the muscle cells of heart and blood vessels
• diuretics to remove extra water and sodium from the body, thereby reducing the amount of fluid in the blood
• beta blockers to slow down the heart rate and therefore reduce the amount of blood traveling through the blood vessels

Lifestyle strategies

Both conditions may benefit from changes in diet, exercise, and activity levels, if these changes are applicable to the individual.

A person may want to try lifestyle changes such as:

• establishing a regular sleep and wake schedule
• eating a balanced diet and not skipping meals
• limiting caffeine and alcohol intake
• getting regular exercise
• finding healthy ways to reduce stress

Treating high blood pressure can also involve several lifestyle changes, some of which overlap with the treatment for migraine:

• reducing salt intake
• eating a balanced diet
• staying active
• cutting down on alcohol
• making efforts to maintain a moderate weight
• drinking less caffeine
• stopping smoking

When to contact a doctor

If a person is experiencing persistent high blood pressure or recurrent migraine episodes, it is a good idea to seek a medical evaluation to avoid any potential complications.

A person should seek emergency medical attention if they have a sudden and severe increase in blood pressure during a migraine headache.

Anecdotally, a person may need emergency medical attention if they experience:

• a migraine episode after a head injury
• a migraine episode lasting longer than 72 hours
• a sudden, severe headache that feels like “the worst headache of their life”
• changes in vision or mental status
• weakness or numbness during a migraine episode
• a migraine episode along with a seizure
• a migraine episode along with a fever or stiff neck

Learn more about when a person should go to hospital for migraine.

Summary

While doctors do not know the exact link, research suggests there may be a connection between high blood pressure and migraine. With further research, doctors may begin to understand the link between the two conditions, and more targeted approaches may become available.

A person who has both migraine and high blood pressure should work closely with a healthcare professional to determine the best medications and lifestyle strategies to manage their conditions.