Treatment of Headache Reduces Blood Pressure Among Most Patients with Migraine and Elevated Blood Pressure
Authors: Hannah Kareff, Shellyann Sharpe, Chiraag Gupta, Benjamin W. Friedman
Journal: American Journal of Emergency Medicine, 2025
Conclusions:
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Most patients with migraine and elevated BP experience BP improvement after headache treatment, without needing additional anti-hypertensive medication.
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Patients without diagnosed hypertension are more likely to have BP reduction associated with pain relief.
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This suggests that headache treatment alone may be sufficient for many patients with acutely elevated BP in the ED, reducing unnecessary antihypertensive medication use.
Methods:
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Data Source: Combined results from four ED-based migraine clinical trials.
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Inclusion Criteria:
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Patients with moderate or severe migraine.
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BP readings moderately elevated or worse.
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Treatment Groups: Patients received one of the following:
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Metoclopramide + dexamethasone
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Metoclopramide + methylprednisolone acetate
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Metoclopramide + diphenhydramine
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Hydromorphone
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Prochlorperazine + diphenhydramine
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Outcome Measures:
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BP and pain scores (0-10 scale) were recorded before medication administration and one hour after treatment.
Results:
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Total Participants: 729
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97 patients (13.3%) had moderately elevated BP or worse.
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Key Findings:
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Among patients without a history of hypertension, BP reduction correlated with pain reduction (B coefficient = 0.04, p = 0.01).
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Among hypertensive patients, pain reduction did not significantly correlate with BP changes (B coefficient = 0.03, p = 0.25).
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BP improvement rates:
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73.2% (95% CI, 64.2-82.2%) experienced a decrease in diastolic BP.
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78.4% (95% CI, 70.0-86.7%) experienced a decrease in systolic BP.
Kareff, H., Sharpe, S., Gupta, C. and Friedman, B.W., 2025. Treatment of headache reduces blood pressure among most patients with migraine and elevated blood pressure. The American Journal of Emergency Medicine.