Diet and Health FAQ

Tagged As: Hypertension Headache

Question:
I have recently seen an over 40 year old white female patient in Urgent Care who had an extremely elevated blood pressure AND a migraine headache. This is the beginning of her history. She stated that she has her migraine headache forever. When asked, she added that she was told by a doctor that she has hypertension about three years ago. She admits that she has some stress in her life. She also stated that she has a high drug tolerance but denies history of drug abuse in the past. I wanted to send her to the ER because of her condition and some other reasons, but she said that the ER wil not take her anymore. This sounds strange to me. Why, I asked her. She said that the ER as well as the NP who is her PCP had told her that her problem, elevated BP and migraine headache should be handled by the PCP, and I guess because of her capitated insurance. She is on ace-inhibitors, calcium channel blockers, diuretics, prozac, soma, tylenol #3, among others. She had taken her drugs as prescribed except her evening dose. About a year ago she had a head CT scan done and it was negative. Other than an elevated cholesterol level her previous labs show that she has no other significant abnormal lab values. My question is this. If you work in an Urgent Care setting, with so little information on a new patient, how do you rule out that a patient's headache is not caused from her elevated BP, or that her bad migraine headache is not the cause of her hypertension, or that either the migraine headache or the hypertension is not causing the other problem to worsen? Or, does it not matter and simply treat the symptoms and refer her back to her PCP? What would be your priorities, and how would you handle this kind of situation? I am looking forward to learn from anyone who can share his/her successful experience or different approach to solving this kind of a problem with me.

Answer:
Yes, she is on ace-inhibitor+ calcium channel blocker. These both drugs can worsen migraine. ACE-inhibitors are indirect vasodilators, Ca-channel-b:s direct ones. When you see a migraine patient developing hypertension, always start with a beta blocker. This is good also for migraine patikents without hypertension to prevent migraine attacks. I use selective-long-acting beta-blockers, the best so far is bisoprol fumarate in a dose of 5-20mg/day. If the BP is not controlled by this measure, add HTC 12,5mg and so on but avoid vasodilators.