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In patients without diagnosed hypertension, treating migraine effectively reduces both pain and elevated blood pressure—often eliminating the need for anti-hypertensive drugs in the emergency setting.
An analysis of emergency department data from 4 migraine studies revealed that headache medications can markedly diminish elevated blood pressure (BP) in patients experiencing acute migraine attacks—particularly in those without a prior hypertension diagnosis.
While emergency clinicians often grapple with whether to prescribe anti-hypertensive drugs alongside migraine treatment for those arriving with both severe headache and high BP, this new evidence suggests that focusing on headache relief may be enough to improve both pain and BP in most cases. Researchers examined 729 patients presenting with moderate or severe migraines. These patients received one of several medication regimens including combinations of metoclopramide with dexamethasone, methylprednisolone acetate, or diphenhydramine, as well as hydromorphone or prochlorperazine with diphenhydramine.
BP and pain scores (rated 0–10) were recorded prior to treatment and 1 hour afterwards. About 13.3% (97 of 729) of patients had moderately elevated or higher BP upon arrival. In those with elevated BP but no prior diagnosis of hypertension (53 patients), reductions in pain were strongly linked with a decrease in mean arterial pressure (a measure of overall BP). For those with elevated BP and a history of hypertension (44 patients), no clear link between pain improvement and BP change was observed.
Among all subjects with elevated BP, 73.2% experienced a drop in diastolic BP, and 78.4% experienced improvements in systolic BP within an hour after headache treatment. To sum up, for people with high BP during a migraine attack—but no history of hypertension—headache medicine alone often lowers both pain and BP within an hour. This novel insight opens a new pathway for tackling patients with acute headache and elevated BP—prioritizing symptom relief while closely monitoring BP changes.
The American Journal of Emergency Medicine
Treatment of headache reduces blood pressure among most patients with migraine and elevated blood pressure
Hannah Kareff et al.
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