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Potential Contribution of Hypertension to Evolution of Chronic Migraine and Related Mechanisms

Matteo Cotta Ramusino, Giulia Perini, Marco Capelli

    Journal of Oral & Facial Pain and Headache
    |November 29, 2022
    PubMed

    Insights

    Hypertension may worsen chronic migraine through shared mechanisms like altered vascular tone and autonomic dysregulation. This study found differences in cerebral blood flow and vagal tone in hypertensive migraine patients.

    Area of Science:

    • Neurology
    • Cardiology
    • Physiology

    Background:

    • Chronic migraine is a complex neurological condition.
    • Hypertension is a common comorbidity with potential links to migraine pathophysiology.
    • Understanding the interplay between blood pressure, autonomic function, and migraine chronification is crucial.

    Purpose of the Study:

    • To investigate the role of diastolic and systolic blood pressure (BP) in the evolution of chronic migraine.
    • To explore the impact of BP circadian rhythm on chronic migraine.
    • To identify neurophysiologic differences in cerebral vessel reactivity, autonomic balance, and BP circadian rhythm between migraine groups with and without hypertension.

    Main Methods:

    • Cross-sectional study comparing four groups: high-frequency migraine (≥10 days/month), low-frequency migraine (<10 days/month), with and without hypertension.
    • Utilized nitroglycerin testing for cerebral vessel reactivity.
    • Assessed autonomic balance via tilting tests and analyzed BP circadian rhythm.

    Main Results:

    • Hypertensive high-frequency migraineurs showed a significantly greater decrease in cerebral blood flow velocity compared to other groups (P = .037).
    • Hypertensive individuals (both high and low frequency) exhibited reduced vagal tone decrease in orthostatic position and a higher vagal to sympathetic tone ratio (P = .032, P = .014, P = .033).
    • Non-hypertensive high-frequency migraineurs had a higher, though not statistically significant, prevalence of systolic nondippers (67%) versus low-frequency migraineurs (25%; P = .099).

    Conclusions:

    • Hypertension appears to contribute to the chronic progression of headache disorders.
    • Shared mechanisms, including vascular tone alteration and autonomic dysregulation, may link hypertension and chronic migraine.
    • Further research into these shared pathways could inform novel therapeutic strategies for migraine management.
    Abstract

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