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. 2022 Summer;36(3-4):221–228.
doi: 10.11607/ofph.3174. Epub 2022 Nov 28.

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

Matteo Cotta Ramusino, Giulia Perini, Marco Capelli, Gloria Vaghi, Roberto Fogari, Daniele Bosone, Alfredo Costa

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

Matteo Cotta Ramusino et al. J Oral Facial Pain Headache. 2022 Summer.

Abstract

Aims: To investigate the potential contributions of diastolic and systolic blood pressure (BP) and the circadian rhythm of BP to chronic migraine evolution.

Methods: This cross-sectional study included four groups of patients selected based on migraine frequency (high frequency ≥ 10 days per month and low frequency < 10) and on the presence of hypertension. Among-group and pairwise comparisons were carried out to investigate potential neurophysiologic differences in the cerebral vessel reactivity to a nitroglycerin test, in autonomic balance (tilting test), and BP circadian rhythm.

Results: A more marked decrease in cerebral blood flow velocity was observed in hypertensive high-frequency migraineurs compared to all other groups (P = .037). Moreover, a smaller decrease in vagal tone was recorded in the orthostatic position in hypertensive subjects, whether they were high- (P = .032) or low-frequency migraineurs (P = .014), with a consistently higher vagal to sympathetic tone ratio (P = .033). Finally, in nonhypertensive subjects, a higher but not significant prevalence of systolic nondippers was detected in high-frequency migraineurs (67%) compared to low-frequency subjects (25%; P = .099).

Conclusion: These findings suggest that hypertension may contribute to the chronic evolution of headache with mechanisms shared with migraine; ie, vascular tone alteration and autonomic dysregulation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial, financial, or nonfinancial relationships that could be construed as a potential conflict of interest. This study was supported by a Research Grant of Ricerca Corrente from the Italian Ministry of Health to IRCCS C. Mondino Foundation.

Figures

Fig 1
Fig 1
Vm of MCA during nitroglycerin test at different time points. *Significant difference (P < .05) at 20 minutes using Kruskal-Wallis test.
Fig 2
Fig 2
Sympathetic and vagal tone response during tilting test. Autonomic tone was expressed as mean ± CI (confidence interval set at 95%). (a) Patients with low-frequency migraine. (b) Patients with high-frequency migraine. Sim = sympathetic tone (low-frequency RR/diastolic blood pressure); vag = vagal tone (high-frequency RR/RR interval); b = baseline state; o = orthostatic position; var = variation from baseline to orthostatic position. *Significant (P < .05) pairwise comparison of vagal tone variation using Mann-Whitney U test.
Fig 3
Fig 3
Percent quantification of systolic and diastolic nocturnal dipping.
Fig 4
Fig 4
Proportion of patients presenting with (a) systolic and (b) diastolic nocturnal dipping. 0 = nondippers and reverse dippers; 1 = dippers.
See this image and copyright information in PMC

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