High Blood Pressure Headache: Medical Myth or True Health Concern?

“We don’t consider [headaches] a way of determining whether a person has hypertension because we know that for most people, when the blood pressure is mildly elevated there are little or no symptoms at all,” Ferdinand says.

However, if the patient takes appropriate lifestyle and therapeutic interventions, including aerobic exercise, avoiding stress, stopping smoking, losing weight and taking anti-hypertension medication, they will often report less generalized heaviness in their head and less fatigue. 

While headaches do not always accompany high blood pressure, there are some emergent situations in which a severe headache is one of the symptoms.

When severe headache and high blood pressure signal an emergency

Sudden headaches can occur during hypertensive emergencies, which typically arise when underlying hypertension rapidly worsens and there are signs of damage to a vital organ.

In this scenario, severely high blood pressure of 180 mmHg/120 mmHg (millimeters of mercury) or above could be coupled with head pain that feels like a throb or pulse that slowly worsens or lasts for hours or even days, according to the Cleveland Clinic.

Other symptoms of hypertensive emergency include blurred vision, nausea or vomiting, change in mental status, chest pain, numbness and cough. This condition 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. The AHA says to call 911 in this scenario. 

Read more about the stages of hypertension

“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 there’s active organ damage occurring.”

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

People experiencing a hypertensive emergency should not try to lower their blood pressure at home, 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 potentially dangerous side effects.

Severe hypertension

Severe hypertension is a more common condition than a hypertensive emergency. This occurs when blood pressure is 180/120 mmHg or higher and there are no 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.

This situation does not necessarily require a trip to the emergency room. However, it’s still important to contact your medical provider if you have concerns about your blood pressure numbers. Unusual or sudden headaches should also be discussed with your medical professional.

Severe hypertension often occurs when people who have been prescribed blood pressure medicine do not take it or stop taking it for some time. In this situation, doctors will try to address whatever barriers prevented the patient from taking their medication regularly, whether it’s cost, accessibility, side effects or inconvenience.

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 not harmful unless it ruptures. When that happens, “it just hits you like a hammer,” Whelton says. "People generally describe it as the most severe headaches I’ve ever had. It’s often associated with nausea and vomiting.”

Ischemic stroke

An ischemic stroke is caused by a blockage in an artery that is either in the brain or 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 of ischemic stroke.

Hemorrhagic stroke

High blood pressure is a primary cause of hemorrhagic stroke, where a blood vessel in the brain ruptures and blood spills into the brain or the sac that surrounds the brain. Approximately 8 to 15 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, Whelton says.

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

When were headaches and high blood pressure first linked?

The hypertension headache connection 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 his famous last words: “I have a terrific pain in the back of my head.”

His cause of death was identified 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.