The Interplay Between Migraine and Blood Pressure
Migraine and hypertension are two common conditions that often coexist. Research indicates a significant association between them, with studies showing that individuals with a history of migraines have a higher risk of developing hypertension. One study of women found that those with migraine without aura had a 21% increased risk of developing hypertension, while those with migraine with aura had a 9% increased risk. This comorbidity complicates treatment, as many effective migraine medications can have an impact on the cardiovascular system.
Some migraine medications relieve pain by tightening blood vessels in the head. However, this vasoconstrictive effect isn't always localized and can affect blood vessels throughout the body, leading to an increase in systemic blood pressure. For individuals with pre-existing or uncontrolled hypertension, this side effect can be dangerous. Therefore, a thorough discussion with a healthcare provider about cardiovascular health is essential before starting any migraine treatment.
Medications That Can Elevate Blood Pressure
Several classes of migraine medications are known to potentially increase blood pressure. Understanding which drugs carry this risk is the first step in making an informed treatment decision.
Triptans: This class of prescription medication, including sumatriptan (Imitrex) and rizatriptan (Maxalt), is a first-line treatment for acute migraine attacks. They work by stimulating serotonin receptors, which constricts blood vessels and blocks pain pathways in the brain. While effective, this vasoconstriction can also cause a rapid increase in blood pressure, even in people without a history of hypertension. Triptans are generally contraindicated for individuals with uncontrolled hypertension, coronary artery disease, or a history of stroke.
Ergotamines: Medications like dihydroergotamine (Migranal, Trudhesa) are effective for migraines that last longer than 24 hours. Similar to triptans, they work by constricting blood vessels. Due to this mechanism, they are not recommended for people with high blood pressure, coronary artery disease, or kidney or liver disease.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Common over-the-counter and prescription pain relievers like ibuprofen (Advil, Motrin) and naproxen (Aleve) are often used for mild to moderate migraine pain. However, NSAIDs can cause the body to retain fluid and may decrease kidney function, leading to higher blood pressure. Studies have shown that ibuprofen, in particular, is associated with a significant increase in systolic blood pressure compared to other NSAIDs like celecoxib.
Tricyclic Antidepressants: Amitriptyline is sometimes used as a prophylactic treatment to reduce the frequency of migraines. Although rare, it has been shown to induce hypertension, even at the lower doses used for migraine prevention. The proposed mechanism involves the blockade of norepinephrine reuptake, which can increase vascular reactivity.
Safer Treatment Options for Patients with Hypertension
For migraine sufferers with high blood pressure, selecting a treatment that won't exacerbate their cardiovascular condition is paramount. Fortunately, several newer classes of medication and other established treatments offer safer profiles.
CGRP Inhibitors: Calcitonin Gene-Related Peptide (CGRP) inhibitors are a newer class of medication designed for both acute treatment and prevention of migraines. This class includes monoclonal antibodies like erenumab (Aimovig) and gepants like ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT). CGRP is a potent vasodilator, and blocking its activity was initially a concern for cardiovascular safety. However, most large-scale studies have found that CGRP monoclonal antibodies do not cause significant cardiovascular adverse effects compared to placebo. While some post-marketing reports have noted cases of increased blood pressure with erenumab and gepants, these are considered infrequent. Still, monitoring blood pressure is advised, especially when starting these medications.
Gepants (Oral CGRP Antagonists): Medications like Nurtec ODT (rimegepant) and Ubrelvy (ubrogepant) are oral gepants that block CGRP receptors. They are effective for acute migraine treatment without the vasoconstrictive effects of triptans. While generally considered safe for patients with cardiovascular risks, the FDA has added warnings that hypertension can occur or worsen with their use. These events are not common, but patients should be aware of the possibility.
Lasmiditan (Reyvow): Lasmiditan is another option for acute migraine treatment. It targets a specific serotonin receptor (5-HT1F) that does not cause vasoconstriction, making it a suitable alternative for patients with cardiovascular contraindications to triptans.
Preventive Medications: Some blood pressure-lowering medicines are also used for migraine prevention. Beta-blockers (e.g., propranolol, metoprolol) and angiotensin receptor blockers (e.g., candesartan) can effectively treat both conditions simultaneously.
Comparison of Migraine Medication Classes
| Medication Class | Mechanism Affecting Blood Pressure | Recommended for Patients with HBP? | Example(s) |
|---|---|---|---|
| Triptans | Vasoconstriction (tightening of blood vessels) | No (especially if uncontrolled) | Sumatriptan, Rizatriptan |
| NSAIDs | Can cause fluid retention and decrease kidney function | Caution Advised; some are riskier than others | Ibuprofen, Naproxen |
| Ergotamines | Vasoconstriction | No | Dihydroergotamine |
| CGRP Inhibitors | Do not cause direct vasoconstriction | Generally Yes, with monitoring | Erenumab, Rimegepant (Nurtec), Ubrogepant (Ubrelvy) |
| Lasmiditan | No vasoconstriction | Yes | Reyvow |
| Beta-Blockers | Lower blood pressure | Yes (can treat both conditions) | Propranolol, Metoprolol |
Conclusion
The question of whether migraine medication can cause high blood pressure has a clear answer: yes, certain types can. Vasoconstrictive drugs like triptans and ergotamines, along with some commonly used NSAIDs, pose a risk to individuals with or without pre-existing hypertension. However, the landscape of migraine treatment has evolved significantly. Newer classes of drugs, such as CGRP inhibitors and lasmiditan, offer effective relief without the cardiovascular risks associated with older medications. Additionally, some preventive medications can treat both migraines and high blood pressure concurrently. The key takeaway is the critical importance of a personalized approach. Consulting with a healthcare provider to review one's cardiovascular health and discuss all medication options is essential for safely and effectively managing migraines.
For more information on migraine treatments, you can visit the Mayo Clinic's guide to Migraine Diagnosis and Treatment.
