Headaches and high blood pressure

As a headache specialist, one of the most common questions I receive is whether a patient's frequent head pain is a direct result of high blood pressure. It is a common misconception that mild or moderate hypertension causes daily headaches; in fact, high blood pressure is often called the "silent killer" precisely because it usually presents with no symptoms at all. In most cases, a typical tension headache or migraine is not caused by your blood pressure. However, when blood pressure reaches extreme levels, typically 180/120 mmHg or higher, it can trigger what we call a hypertensive crisis. This is a medical emergency where the pressure inside the vessels becomes so great that it leads to brain swelling or "cerebral edema," resulting in a distinct, throbbing headache that often feels worse with activity.

It is crucial to know when a headache moves from a routine nuisance to a life-threatening problem. If you experience a sudden, severe "thunderclap" headache accompanied by blurred vision, chest pain, confusion, or shortness of breath, you must seek emergency care immediately. This is not the time to wait for an office appointment; these symptoms suggest that the high blood pressure is causing acute organ damage. While I always encourage my patients to monitor their blood pressure at home, I remind them that the goal is long-term management to prevent strokes and heart disease, rather than assuming every minor ache is a sign of a spike. If your blood pressure is consistently high, we need to manage it, but if it is high and you have a new, severe headache, it is a sign that your body is in crisis. If you want to investigate more whether your headaches me be related to your blood pressure, click here to schedule a consultation. Wondering if your blood pressure is causing your headaches? Click here to schedule a consultation.

When to Seek Emergency Care for a Headache

Go to the ER or call 911 immediately if you experience any of the following:

• Sudden Onset: A "thunderclap" headache that reaches maximum, unbearable intensity within seconds or minutes.

• Stroke Symptoms: Sudden weakness, numbness, or drooping on one side of the face or body, or difficulty speaking/slurred speech.

• Neurological Changes: Sudden confusion, vision loss, double vision, or loss of balance and coordination.

• Signs of Infection: A severe headache accompanied by a stiff neck and a high fever.

• Trauma: Any new, severe headache following a fall or a direct blow to the head.

• Hypertensive Crisis: A headache occurring with blood pressure over 180/120 mmHg, especially if you also have chest pain or shortness of breath.