The Paradoxical Significance of Headache in Hypertension

BACKGROUND The cardiovascular prognostic value of various types of headache, particularly migraine, in the general population remains controversial. The aim of the present study was to assess their prognostic value for all-cause, cardiovascular and stroke mortalities in hypertensive patients. METHODS A total of 1,914 hypertensive individuals were first categorized according to the absence or presence of headache and thereafter according to the 3 subtypes of headache: migraine, daily headache, and other headache. RESULTS Multiple regression analysis demonstrated that all headache types were predicted by gender (women), diastolic blood pressure, absence of diabetes, secondary hypertension, and a trend for severe retinopathy. After 30 years of follow-up, 1,076 deaths were observed, 580 of whom were from cardiovascular cause and 97 from acute stroke. In a multivariable Cox model adjusted for major confounders, patients having headache had a decreased risk for all-cause mortality (hazard ratio (HR) 0.82; 95% confidence interval (CI) 0.73–0.93) and cardiovascular mortality (HR 0.80; 95% CI 0.68–0.95), but not for stroke mortality (HR 1.00; 95% CI 0.70–1.43). When considering only patients with headache, “daily headache” had a nonsignificant better prognostic value for all-cause and cardiovascular mortality than “other headache” (HR 0.83; 95% CI 0.68–1.01; HR 0.89; 95% CI 0.69–1.16, respectively) and “migraine” (HR 0.85; 95% CI 0.65–1.11; HR 0.78; 95% CI 0.55–1.10, respectively). CONCLUSION Presence of nonspecific headache in hypertensive patients has a paradoxical significance in that it is associated with a high-risk profile but does not result in a worse prognosis over the long term.