The Headache & Hypertension Paradox
Hypertension is a major risk factor for cardiovascular diseases, and the data indicate that untreated hypertension shortens life expectancy by approximately 5 years. It continues to be a major public health problem whose prevalence is increasing worldwide. A research has been carried out to determine the prognostic value for cardiovascular and stroke mortalities in hypertensive patients.
In the study, 1914 hypertensive patients were enrolled and divided as per absence or presence of headache and according to 3 subtypes of headache: migraine, daily headache, and other headache. Results depicted that all headache types were predicted by gender (women), diastolic blood pressure, absence of diabetes, secondary hypertension, and a trend for severe retinopathy. After 30 years of follow-up, 1,076 deaths occurred, out of which 580 died due to cardiovascular cause and 97 from acute stroke.
In a multivariable Cox model adjusted for major confounders, patients having headache had a decreased risk for all-cause mortality (hazard ratio (HR) 0.82; 95% confidence interval (CI) 0.73-0.93) and cardiovascular mortality (HR 0.80; 95% CI 0.68-0.95), but not for stroke mortality (HR 1.00; 95% CI 0.70-1.43). When considering only patients with headache, "daily headache" had a non-significant better prognostic value for all-cause and cardiovascular mortality than "other headache" (HR 0.83; 95% CI 0.68-1.01; HR 0.89; 95% CI 0.69-1.16, respectively) and "migraine" (HR 0.85; 95% CI 0.65-1.11; HR 0.78; 95% CI 0.55-1.10, respectively).
In the conclusion, nonspecific headache has been shown to be a risk factor but does not result in a worse prognosis over the long term.