What levels of hypertension are associated with headache
An often bilateral and pulsating headache may be associated with an acute rise in a systolic blood pressure to ≥180 mm Hg and/or diastolic to ≥120 mm Hg.
It remits after normalization of blood pressure.
Mild or moderate chronic hypertension does not appear to cause headache.
Hypertensive encephalopathy presents with persistent elevation of blood pressure to ≥180/120 mm Hg (typically in those with a history of chronic hypertension) and at least two of the following: confusion, reduced level of consciousness, visual disturbance including blindness, and seizures.
Headache is reported at presentation in 22%. In those previously normotensive, encephalopathy may develop with blood pressure as low as 160/100 mm Hg.
At increasing levels of blood pressures beyond the upper range of cerebral autoregulation, endothelial permeability increases and cerebral edema occurs, most prominently in the parieto-occipital white matter on MRI.
