Elevated blood pressure and analgesic overuse in chronic daily headache: an outpatient clinic-based study from China.

Qingqing Huang,Xiping Liang,Jing Wang,Ge Tan,Nan Li,Wangwen Li,Guangcheng Qin,Lixue Chen,Jiying Zhou

doi:10.1186/1129-2377-14-51

Abstract

BackgroundMany studies have reported that hypertension is common in chronic daily headache (CDH) and its subtype chronic migraine (CM), but the reason is still poorly understood. Our clinical literature review suggested that analgesic overuse may be associated with elevated blood pressure (BP), so we performed the present study to investigate the frequency of elevated BP and its link with analgesic overuse in CDH and its subtypes.MethodsA cross-sectional study was conducted in neurology outpatients with a diagnosis of CDH according to International Headache Society criteria. CDH patients were classified into CM and non-CM groups, and subclassified with or without analgesic overuse.ResultsElevated BP was present in 27.96% of CDH patients. Compared with non-CM patients, patients with CM had a longer duration of headache and more severe pain intensity, and a family history of headache and analgesic overuse were also more common, but the elevated BP frequency was not different between the two groups. Almost one-third of the patients had analgesic overuse; 96.8% of which comprised acetaminophen-containing agents. Those with analgesic overuse had a higher frequency of headache than those without analgesic overuse in both the CM and non-CM groups.ConclusionsAlthough the CM patients had a longer duration of headache, more severe intensity, the frequency of elevated BP wasn’t higher than non-CM group. Analgesic overuses maybe the reason of higher frequency of elevated BP in CDH and its subtypes. This may have predictive value for clinicians to improve CDH management.

Highlights

Many studies have reported that hypertension is common in chronic daily headache (CDH) and its subtype chronic migraine (CM), but the reason is still poorly understood
To be classified as CM, the patients should satisfy the following conditions: Headache on ≥15 days/month for at least 3 months, Occurring in a patient who has at least 8 days/month fulfilling criteria 1.1, not attributed to another causative disorder. Another three subtypes of CDH were classified as nonCM in order to investigate differences in frequency of elevated blood pressure (BP) in CM compared with other chronic headache types
Compared with non-CM group, CM patients had a longer duration of headache than non-CM patients (P < 0.000); pain intensity was more severe,more patients had a family history of headache; and more were more likely to have analgesic overuse, the average number of headache days per month was higher in non-CM than in CM patients

Summary

Introduction

Many studies have reported that hypertension is common in chronic daily headache (CDH) and its subtype chronic migraine (CM), but the reason is still poorly understood. There is a relationship between hypertension and CDH and its subtype CM [3,4,5], which suggests that prevalence of hypertension is significantly higher in CDH or CM than in other headache groups. CM is the most common subtype of CDH [6,7,8,9], Mathew et al reported that patients with CDH transformed from originally episodic migraine had a higher possibility of hypertension [10], but the reason was poorly understood. In CDH subtypes, CM patients are more likely to have analgesic overuse, which is a significant predictor of poor outcome

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Results

Discussion

Conclusion