High pulse pressure protects against headache
Prospective and cross-sectional data (HUNT study)
Abstract
Background: Many antihypertensive drugs are also used as migraine prophylactics, but the relationship between blood pressure and headache is not been well understood. The objective of the present study was to explore the association between blood pressure and headache prevalence, and the effect of antihypertensive medication on this relationship, using both cross-sectional and prospective data from a large population.
Methods: We used data from two large epidemiologic studies, the Nord-Trøndelag Health Survey 1984–1986 (HUNT-1) and 1995–97 (HUNT-2), to evaluate the association between blood pressure (systolic, diastolic, mean arterial, and pulse pressure) and migraine and nonmigrainous headache.
Results: Increasing systolic blood pressure was associated with decreasing prevalence of having nonmigrainous headache or migraine. The most consistent and robust finding, however, was that increasing pulse pressure was linked to decreased prevalence of both nonmigrainous headache and migraine, evident for both sexes in the prospective and cross-sectional analyses. In subjects using antihypertensive medication, this finding was less clear.
Conclusion: Both increased systolic blood pressure and pulse pressure are related to arterial stiffness and may decrease headache prevalence through modulation of the baroreflex arch, which in turn generates hypoalgesia. This is due to a phenomenon called hypertension-associated hypalgesia. Stimulation of the baroreflex arch in response to increased blood pressure is assumed to inhibit pain transmission at both spinal and supraspinal levels, possibly because of an interaction of the centers modulating nociception and cardiovascular reflexes in the brainstem.
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REFERENCES
1.
Walker CH. Migraine and its relationship to hypertension. BMJ 1959;2:1430–1433.
2.
Badran RH, Weir RJ, McGuiness JB. Hypertension and headache. Scott Med J 1970;15:48–51.
3.
Markush RE, Karp HR, Heyman A, O’Fallon WM. Epidemiologic study of migraine symptoms in young women. Neurology 1975;25:430–435.
4.
Buring JE, Hebert P, Romero J, et al. Migraine and subsequent risk of stroke in the Physicians’ Health Study. Arch Neurol 1995;52:129–134.
5.
Rasmussen BK, Olesen J. Symptomatic and nonsymptomatic headaches in a general population. Neurology 1992;42:1225–1231.
6.
Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd edition. Cephalalgia 2004;24 (suppl 1):1–160.
7.
Hagen K, Stovner LJ, Vatten L, Holmen J, Zwart JA, Bovim G. Blood pressure and risk of headache: a prospective study of 22 685 adults in Norway. J Neurol Neurosurg Psychiatr 2002;72:463–466.
8.
Fuchs FD, Gus M, Moreira LB, Moreira WD, Goncalves SC, Nunes G. Headache is not more frequent among patients with moderate to severe hypertension. J Hum Hypertens 2003;17:787–790.
9.
Wiehe M, Fuchs SC, Moreira LB, Moraes RS, Fuchs FD. Migraine is more frequent in individuals with optimal and normal blood pressure: a population-based study. J Hypertens 2002;20:1303–1306.
10.
Tzourio C, Gagniere B, El Amrani M, Alperovitch A, Bousser MG. Relationship between migraine, blood pressure and carotid thickness: a population-based study in the elderly. Cephalalgia 2003;23:914–920.
11.
Gudmundsson LS, Thorgeirsson G, Sigfusson N, Sigvaldason H, Johannsson M. Migraine patients have lower systolic but higher diastolic blood pressure compared with controls in a population-based study of 21,537 subjects: the Reykjavik Study. Cephalalgia 2006;26:436–444.
12.
Law M, Morris JK, Jordan R, Wald N. Headaches and the treatment of blood pressure: results from a meta-analysis of 94 randomized placebo-controlled trials with 24,000 participants. Circulation 2005;112:2301–2306.
13.
Hagen K, Zwart JA, Vatten L, Stovner LJ, Bovim G. Head-HUNT: validity and reliability of a headache questionnaire in a large population-based study in Norway. Cephalalgia 2000;20:244–251.
14.
Tronvik E, Stovner LJ, Hagen K, Holmen J, Bovim G, Zwart J-A. Hypertension-associated hypalgesia: an important mechanism in headache and other pains. In: Olesen J, Jensen TS. From Basic Pain Mechanisms to Headache. Vol 14. Oxford: Oxford University Press, 2006:121–125.
15.
Hagen K, Zwart JA, Holmen J, Svebak S, Bovim G, Stovner LJ. Does hypertension protect against chronic musculoskeletal complaints? The Nord-Trøndelag Health Study. Arch Intern Med 2005;165:916–922.
16.
Dworkin BR, Filewich RJ, Miller NE, Craigmyle N, Pickering TG. Baroreceptor activation reduces reactivity to noxious stimulation: implications for hypertension. Science 1979;205:1299–1301.
17.
Guasti L, Grimoldi P, Diolisi A, et al. Treatment with enalapril modifies the pain perception pattern in hypertensive patients. Hypertension 1998;31:1146–1150.
18.
Zamir N, Shuber E. Altered pain perception in hypertensive humans. Brain Res 1980;201:471–474.
19.
Ghione S. Hypertension-associated hypalgesia: evidence in experimental animals and humans, pathophysiological mechanisms, and potential clinical consequences. Hypertension 1996;28:494–504.
20.
Murphy AZ, Ennis M, Rizvi TA, Behbehani MM, Shipley MT. Fos expression induced by changes in arterial pressure is localized in distinct, longitudinally organized columns of neurons in the rat midbrain periaqueductal gray. J Comp Neurol 1995;360:286–300.
21.
Virtanen R, Jula A, Huikuri H, et al. Increased pulse pressure in associated with reduced baroreflex sensitivity. J Hum Hypertens 2004;18:247–252.
22.
Guasti L, Zanotta D, Mainardi LT, et al. Hypertension-related hypoalgesia, autonomic function and spontaneous baroreflex sensitivity. Auton Neurosci 2002;99:127–133.
23.
Haberthür C, Schächinger H, Langewitz W, Ritz R. Effect of beta blockade with and without sympathomimetic activity (ISA) on sympathovagal balance and baroreflex sensitivity. Clin Physiol 1999;19:143–152.
24.
Darne B, Girerd X, Safar M, Cambien F, Guize L. Pulsatile versus steady component of blood pressure: a cross-sectional analysis and a prospective analysis on cardiovascular mortality. Hypertension 1989;13:392–400.
25.
Bernstein IM, Thibault A, Mongeon JA, Badger GJ. The influence of pregnancy on arterial compliance. Obstet Gynecol 2005;105:621–625.
26.
Visontai Z, Lenard Z, Studinger P, Rigo J Jr, Kollai M. Impaired baroreflex function during pregnancy is associated with stiffening of the carotid artery. Ultrasound Obstet Gynecol 2002;20:364–369.
27.
van Popele NM, Bos WJ, de Beer NA, et al. Arterial stiffness as underlying mechanism of disagreement between an oscillometric blood pressure monitor and a sphygmomanometer. Hypertension 2000;36:484–488.
28.
Lund-Larsen PG. Blood pressure measured with a sphygmomanometer and with Dinamap under field conditions: a comparison. Nor J Epidemiol 1997;7:235–241.
29.
Dahlof CG, Linde M, Linton-Dahlof P. Migran-Kliniska aspekter. Lund: Studentlitteratur, 2003:107.
30.
Lipton RB, Scher AI, Kolodner K, Liberman J, Steiner TJ, Stewart WF. Migraine in the United States: epidemiology and patterns of health care use. Neurology 2002;58:885–894.
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Published online: April 14, 2008
Published in print: April 15, 2008
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