Hypertension in headache patients? A clinical study

Pietrini, Umberto; Luca, Massimo De; Santis, Giulia De

doi:10.1111/j.1600-0404.2005.00476.x

Cited by 22 publications

(23 citation statements)

References 28 publications

(37 reference statements)

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“…But hypertension could also be one of the factors leading to exacerbation of the frequency and severity of attacks, both in migraine and tension-type headache, and the evidence supporting a connection between chronic hypertension and headache is scant [15, 19]. As a result, in our study hypertension was not found to be a major factor in the differentiation of secondary headaches from primary ones.…”

Section: Discussioncontrasting

confidence: 57%

What clues are available for differential diagnosis of headaches in emergency settings?

et al. 2008

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The correct diagnosis of headache disorders in an emergency room is important for developing early management strategies and determining optimal emergency room activities. This prospective clinical based study was performed in order to determine demographic and clinical clues for differential diagnosis of primary and secondary headache disorders and also to obtain a classification plot for the emergency room practitioners. This study included 174 patients older than 15 years of age presenting in the emergency room with a chief complaint of headache. Definite headache diagnoses were made according to ICHD-II criteria. Classification and regression tree was used as new method for the statistical analysis of the differential diagnostic process. Our 174 patients with headache were diagnosed as basically primary (72.9%) and secondary (27.1%) headaches. Univariate analysis with cross tabs showed three important results. First, unilateral pain location caused 1.431-fold increase in the primary headache risk (p = 0.006). Second, having any triggers caused 1.440-fold increase in the primary headache risk (p = 0.001). Third, having associated co-morbid medical disorders caused 4.643-fold increase in the secondary headache risk (p < 0.001). It was concluded that the presence of comorbidity, the patient’s age, the existence of trigger and relaxing factors, the pain in other body parts that accompanies headache and the quality of pain in terms of location and duration were all important clues for physicians in making an accurate differentiation between primary and secondary headaches.

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Section: Discussioncontrasting

confidence: 57%

What clues are available for differential diagnosis of headaches in emergency settings?

et al. 2008

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“…Prevalence of alcohol use was 74.5% and cigarette smoking 75% in those with CH.Only males included in this study.Liang, 2013 [18]673 male and female CH patients from a Taiwanese National Health DatabaseRetrospective cohort study with 2.5 year median follow-up duration3.6% developed depression over study period. Adjusted HR 5.6% vs. controls but not different from those with migraine; number of bouts/year of CH a risk factor for depression.Study limited to patients diagnosed by neurologist and prescribed standard CH drugs; excluding those with previous psychiatric diagnoses (104 of original 777; 13%).Pietrini, 2005 [19]60 consecutive male and female CH patients seen at an Italian headache centerCross-sectional, based on study examination35% had hypertension, defined as blood pressure ≥ 140/90 on average of 3 blood pressure readings.The authors concluded that the prevalence of hypertension in this group was within expected range given age and sex.Robbins, 2012 [20]49 consecutive male and female CH patients seen in a New York headache clinic over a 3.5 year periodCross-sectional chart reviewPrevalence of depression (PHQ ≥ 1 0) was 6.3% in episodic CH, 11.8% in chronic CH; Anxiety (GAD-7 ≥ 10) prevalence was 15.6% in episodic CH and 11.8% in chronic CH. Prevalence of hypertension was 14%, current or former cigarette smoking was 65.3% and GERD was 8%.Rossi, 2012 [21]210 consecutive male and female CH patients from two Italian headache centersCross-sectional interview and anonymous survey data92.5% of male CH patients and 85.4% of female CH patients reported current or past use of tobacco, statistically significantly higher than prevalence in general population.Self reported data on substance use.Rozen, 2012 [22]1134 US male and female CH patients responding to an internet surveyCross-sectional survey (internet)Prevalence of depression was 24%, suicidal ideation was reported by 55%, sleep apnea by14%, restless leg syndrome by 11%, asthma by 9%.…”

Section: Introductionmentioning

confidence: 99%

The comorbidity burden of patients with cluster headache: a population-based study

2017

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BackgroundEvidence is limited regarding the comorbidity burden of patients with cluster headache (CH). We aimed to characterize comorbid conditions in a cohort of CH patients diagnosed by headache experts, using electronic health record information from the Partners Research Patient Data Registry (RPDR).MethodsWe identified and reviewed the charts of unique patients diagnosed by headache specialists over an 11-year period, and a set of matched controls. Patients were categorized as having Definite, Unconfirmed or no CH. We calculated the prevalence of and tested for statistically significant differences of selected comorbid conditions in these populations.ResultsAn RPDR query identified 170 patients with a free text or ICD diagnosis of cluster headache. 15 records belonging to Partners employees were excluded. 75 patients met diagnostic criteria for CH (Definite CH). 22 had headaches with some features of CH but the diagnosis was uncertain (Unconfirmed CH). In 58 the diagnosis was determined to be inaccurate due to data entry errors. Patients with Definite CH had an average age of 43.4 years; 80% were male. The average time from CH onset to diagnosis was 12.7 years (range 1–51). The average number of yearly emergency department and outpatient visits for the group of Definite CH patients was 4.5 and 25.4, respectively, compared with 1.1 and 6.9 in controls. Of the 55 examined conditions, four were statistically significantly less common in patients with definite CH compared with controls (diabetes, musculoskeletal/orthopaedic problems, “other gastrointestinal diagnoses” and skin conditions) and four were statistically significantly more common (smoking, depression, dental disorders and deviated septum).ConclusionsIn this large population-based study, we identified a surprisingly small number of patients who met strict diagnostic criteria for CH. In these patients, however, we identified a distinct pattern of selected comorbidities. The pattern is somewhat but not entirely consistent with that of the “classic” CH patient depicted in the medical literature. CH patients are frequently diagnosed with sinus or dental problems. Many experience substantial delay in receiving a diagnosis. These things may in part explain the high frequency of medical visits in this population. It is difficult to distinguish conditions that are genuinely comorbid with CH from those that reflect misdiagnoses or medical scrutiny of patients in frequent contact with the healthcare system.

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“…According to the current knowledge, arterial hypertension is believed to enhance the effects of migraine on the vascular wall and concur to the further impairment of the endothelial function in the cerebral vasculature, leading to exacerbation of the frequency and severity of attacks [1,3,4]. In addition, individuals with migraine and hypertension have a higher risk of developing cardiovascular disease, such as ischemic stroke, than normotensive individuals [2,5].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of frovatriptan and other triptans in the treatment of acute migraine of hypertensive and normotensive subjects: a review of randomized studies

Tullo¹,

Bussone²,

Omboni

et al. 2013

Neurol Sci

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Migraine might be associated with high blood pressure (BP), which can cause more severe and more difficult to treat forms of headache. To evaluate the efficacy of frovatriptan and other triptans in the acute treatment of migraine, in patients classified according to a history of arterial hypertension, enrolled in three randomized, double-blind, crossover, Italian studies. Migraineurs with or without aura were randomized to frovatriptan 2.5 mg or rizatriptan 10 mg (study 1), frovatriptan 2.5 mg or zolmitriptan 2.5 mg (study 2), frovatriptan 2.5 mg or almotriptan 12.5 mg (study 3). After treating up to three episodes of migraine in 3 months with the first treatment, patients switched to the alternate treatment for the next 3 months. The present analysis assessed triptan efficacy in 60 subjects with a history of treated or untreated essential arterial hypertension (HT) and in 286 normotensive (NT) subjects. During the study, migraine attacks with aura were significantly more prevalent in HT subjects (21 vs. 13 % NT, p \ 0.001). The proportion of pain free at 2 h did not significantly differ between HTs and NTs for either frovatriptan (25 vs. 26 %) or the comparators (33 vs. 32 %). Pain relief was achieved in significantly (p \ 0.05) fewer episodes in HT subjects for both frovatriptan (41 vs. 52 % NT) and the comparators (48 vs. 58 %). Relapses at 48 h were similarly low in HTs and NTs with frovatriptan (29 vs. 31 %), while they were significantly (p \ 0.05) larger in HTs (62 %) than in NTs (44 %) with comparators. No BP or heart rate increment was observed during the study in HT subjects. No difference in tolerability was reported between HTs and NTs. In conclusion, HT individuals tend to be less responsive than NT migraineurs to triptan therapy. However, frovatriptan, in contrast to other triptans, seems to have a sustained antimigraine effect in both HT and NT patients.

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Hypertension in headache patients? A clinical study

Cited by 22 publications

References 28 publications

What clues are available for differential diagnosis of headaches in emergency settings?

What clues are available for differential diagnosis of headaches in emergency settings?

The comorbidity burden of patients with cluster headache: a population-based study

Efficacy of frovatriptan and other triptans in the treatment of acute migraine of hypertensive and normotensive subjects: a review of randomized studies

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