For several years I have noticed that so many people living with frequent or chronic migraine have mentioned that they have low blood pressure. It’s time to act on this mental note and take a closer look at migraine and blood pressure. Is it just and interesting observation or is there something to be gleaned from it?
Why the interest in a possible migraine-blood pressure connection?
To give you an idea for what’s peaked my curiosity, I’ll share with you a fun poll we did in our Facebook group. Of course, this is not scientific, but I think people with migraine will find it a compelling topic. As of the day this was written, the following results have been reported:
169 people state they have low blood pressure
109 people state they have blood pressure in the lower-normal range
106 people state they have normal blood pressure
41 people state they have blood pressure in the higher-normal range
36 people state they have high blood pressure
Total number of participants – 461
Again, this is not a scientific poll. The information is anecdotal and collected via social media, but the information is interesting. According to the CDC (Center for Disease Control and Prevention), almost half of adults in the United States (47%) have hypertension, defined as a systolic blood pressure greater than 130 mmHg or a diastolic blood pressure greater than 80 mmHg. In our poll, only 8% reported being diagnosed with high blood pressure. For emphasis I repeat – 8% of our participants with migraine compared with 47% of the general population.
Is there research to confirm or dispute this anecdotal observation?
256 out of 461, (56%) of the people responding had normal blood pressure. Since most respondents have frequent or chronic migraine, this confirms the findings in an interesting older study from 2002:
Our findings confirm that high blood pressure is not associated with the complaint of headache in the population. Individuals with migraine-like episodes of headache may have lower blood pressure than individuals without headache.
The results of our unscientific poll confirm the conclusions in the above study as well as the observations we have made in our Migraine Strong Facebook group over the years. ~37% of people said their blood pressure is typically low. Low blood pressure is defined as less than 90/60mmHG at rest.
** While Migraine Strong writes about the latest in migraine treatments, this is not medical advice. We are patient educators and all information you read should be discussed with your doctor.
Low blood pressure and migraine
There are several symptoms of low blood pressure such as fatigue, blurry vision, lightheadedness and dizziness. However, most people with known low blood pressure do not experience symptoms. Running low is their normal and typically not a health concern.
I was unable to find further research or general information linking low blood pressure specifically to migraine. Headache, not migraine, is listed as a known symptom of low blood pressure. While this is an interesting observation, at this point there does not seem to be a connection or reason to believe there is a relationship. Rather, it may be just another “thing that makes you go hmmm” (cue the 1990’s hit).
Migraine and high blood pressure
According to the literature, it seems that many people make the wrong assumption about headache and blood pressure, specifically migraine and high blood pressure. Based on studies, severe headache is only thought to be caused by elevations in blood pressure when a person is having a hypertensive crisis, defined as blood pressure readings of 180/120 mm Hg. A hypertensive crisis is considered a medical emergency as it can lead to stroke, heart attack or other significant medical event if untreated.
According to Thomas Berk MD, a well-known board-certified headache specialist and the medical director of Neura Health, “higher and lower blood pressure both don’t necessarily trigger migraine or are associated with more migraine attacks.” He confirms that there is no migraine-blood pressure link.
What about blood pressure when migraine is frequent or chronic?
It is known that both pain and anxiety can cause elevations in blood pressure. For those people living with chronic migraine or the constant disequilibrium or background of “neurological weirdness,” pain or anxiety may be ever-present.
Pain, anxiety and migraine
Some people in our poll, noted that their blood pressure was normal until they became chronic. Of course, this may be due to many factors, but coping with chronic pain and the quest to find the right combination of treatments could certainly contribute.
During times of acute anxiety and acute pain, blood pressure can be elevated. The good news is that when the anxiety and pain subside, blood pressure usually returns to normal.
Since anxiety often accompanies migraine, especially during the destabilizing effects of vestibular migraine, we have 2 articles to consider reading. Tips to reduce anxiety as well as ACT therapy, a form of cognitive behavioral therapy, that may be very helpful for coping with frequent and chronic symptoms.
Are there special treatment concerns for those with low blood pressure?
In terms of migraine preventive medications, blood pressure medications are commonly used as the first line of treatment. Beta blockers like metoprolol and propanolol are often prescribed. The calcium channel blocker, verapamil, is often prescribed as well. Clearly, if a significant percentage of people living with migraine have low blood pressure or tend to be in the lower range, a doctor must be especially careful when prescribing these medications.
I posed two questions to Dr. Berk to help people with migraine and he graciously responded:
Question 1– Some of the common preventative medications for migraine are also blood pressure medications. When you have a patient with consistently low blood pressure, what are other categories of medications that you frequently prescribe?
Dr. Berk: We would consider either antidepressant to anti-seizure type medications, another medication we like to use then is called memantine which prevents dementia but was also shown in two randomized controlled trials to be effective for migraine prevention. Botox and the CGRP antibody medications are also safe and effective with low blood pressure.
Question 2- Are there some migraine preventives that you avoid prescribing for people with high blood pressure?
Dr. Berk: If you have high blood pressure we might avoid anti-inflammatory medications as they can affect kidney function and also worsen blood pressure. We might also avoid Aimovig. There is a recent warning that has been associated Aimovig with hypertension.
In summary, yes, it looks like many of us living with frequent migraine have another metabolic similarity – normal or low blood pressure. And, perhaps we are less likely to have high blood pressure and the associated risks associated with it.