Abstract
Background
Elevated blood pressure (BP) and headache have long been linked in the medical literature,
although data on association are conflicting. We used previously collected data to
address these related aims: (1) using the National Hospital Ambulatory Medical Care
Survey (NHAMCS), we determined whether elevated BP is more likely in patients who
present to an emergency department (ED) with headache than in patients who present
with other complaints; (2) using data collected in 3 ED-based migraine clinical trials,
we determined the association between improvement in headache pain and improvement
in BP among patients who present to an ED with migraine and elevated BP; (3) using
the data from the migraine clinical trials, we also determined if an elevated baseline
BP identifies a group of patients less likely to respond to standard migraine treatment.
Methods
We analyzed 2 distinct data sets. The first, NHAMCS, is a national probability sample
of all US ED visits. The second is a compilation of data gathered during 3 ED-based
migraine randomized controlled trials. We defined elevated BP as follows: moderate
elevation—systolic BP (SBP) ≥150 mm Hg or diastolic BP (DBP) ≥95 mm Hg; marked elevation—SBP ≥165 mm Hg or DBP ≥100 mm Hg; and severe elevation—SBP ≥180 mm Hg or DBP ≥110 mm Hg. We report the association between headache and elevated BP in NHAMCS using
odds ratios (ORs) with 95% confidence intervals (CI). We report the correlation coefficient
and r2 for the association between improvement in BP and improvement in headache pain in
our clinical trials data set. Finally, using our clinical trials database, we determined
the influence of elevated BP at baseline on response to migraine medication by constructing
a linear regression model in which the dependent variable was improvement in 0 to
10 pain score between baseline and 1 hour, and the primary predictor variable was
presence or absence of elevated BP at baseline.
Results
Headache was the primary complaint in 3.7% (95% CI, 3.4-4.0%) of all US ED visits,
corresponding to 4.8 million (95% CI, 4.2-5.4 million) patient visits. Among US ED
patients, those with headache were more likely than patients with other chief complaints
to have markedly (OR, 1.37; 95% CI, 1.16-1.61) or severely elevated BP (OR, 1.49;
95% CI, 1.17-1.90). In our clinical trials data set of patients with migraine with
moderately elevated BP, there was no correlation between improvement in pain score
and improvement in SBP (r = −0.07, r2 = 0, P = .465) or DBP (r = −0.03, r2 = 0, P = .75). Similarly, there was no correlation between improvement in headache and improvement
in BP among patients with migraine with markedly elevated BP (for SBP, r = −0.19, r2 = 0.04, P = .89; for DBP, r = −0.02, r2 = 0, P = .87), nor among patients with severely elevated BP (for SBP, r = 0.06, r2 = 0, P = .81; for DBP, r = 0.03, r2 = 0, P = .90). Patients with moderately elevated BP had slightly less improvement in their
0 to 10 pain score than patients with BPs below this cutoff (−0.6; 95% CI, −1.2 to −0.1; P = .03). This was more pronounced among patients with markedly elevated BP (−0.9; 95% CI, −1.7 to −0.2).
Conclusions
Although there is an association between elevated BP and headache among patients presenting
to an ED, improvement in headache is not associated with improvement in BP.
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Article Info
Publication History
Published online: May 20, 2014
Accepted:
May 11,
2014
Received in revised form:
April 13,
2014
Received:
March 16,
2014
Footnotes
☆Meetings at which this work has been presented: Society for Academic Emergency Medicine, Atlanta, Georgia, May 2013.
☆☆Grant support: None.
★Conflicts of interest: None.
★★Author contributions: BWF conceived and designed the study. BM, JRW, and AW abstracted data and reviewed the literature. BWF analyzed the data. BWF drafted the manuscript, and all authors contributed substantially to its revision. BWF takes responsibility for the article as a whole.
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© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
