Headache With High Blood Pressure: Causes, When to Worry

Headache With High Blood Pressure — Causes, When to Worry and What to Do

When high blood pressure really causes a headache, the warning signs that need urgent care, and what to do with a high reading. Explained by a Sydney neurologist.

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When a Headache With High Blood Pressure Needs Urgent Care

Most headaches in people with high blood pressure are not caused by it, and most are not dangerous. A few patterns need care straight away, so they come first.

Call 000 — or go to an emergency department — if

a headache comes on suddenly and severely and reaches its worst within a minute (the worst headache of your life), even if it then eases
a very high blood pressure reading (a top number of 180 or more, or a bottom number of 120 or more) comes with chest or back pain, shortness of breath, vomiting, problems with your eyesight, confusion or a seizure: call 000 straight away
your blood pressure is still very high when you measure it again after 5 minutes of sitting quietly, and you have a headache
the headache comes with fever and a stiff neck, a rash that does not fade when pressed, confusion or unusual drowsiness
you are over 50 with a new headache and you notice blurring, double vision, or sight that dims or goes dark in one eye, even if it lasts only a few minutes
the headache comes with sudden loss or dimming of vision (even if brief), double vision, a new drooping eyelid or one pupil larger than the other, slurred speech, sudden severe dizziness or unsteadiness, or numbness, weakness or drooping of the face, an arm or a leg
an eye becomes painful and red, with blurred vision, halos (coloured rings) around lights, or nausea and vomiting
the headache started after a head injury and is getting worse, comes with vomiting, drowsiness or confusion, or you take blood-thinning medicine
the headache comes with a seizure
you are more than 20 weeks pregnant or had a baby in the last 6 weeks and have a severe headache, a headache that does not get better with simple pain relief, blurred vision or flashing lights, sudden swelling of the face, hands or feet, pain under the ribs or in the upper tummy, vomiting with a headache, or a reading of 160/110 or more: go to your maternity unit or an emergency department now; call 000 for a seizure, trouble breathing or chest pain
you have a spinal cord injury at mid-chest level or higher and get a sudden, pounding headache, often with sweating or flushing above the injury: sit upright with your legs down, loosen anything tight, check your bladder, catheter and bowel, and follow your own dysreflexia plan if you have one; call 000 if it does not settle within a few minutes or you cannot find the cause

A sudden, explosive headache, wherever it is felt, can mean bleeding around or into the brain (a subarachnoid or intracerebral haemorrhage), and bleeding into the brain is more likely when blood pressure is high. A very high reading with chest or back pain or shortness of breath can mean the heart or the main artery from the heart is under strain; with vomiting, problems with eyesight, confusion or a seizure, it can mean the pressure is affecting the brain (hypertensive encephalopathy, explained below). A very high reading with a headache needs checking in an emergency department, because only tests can show whether the pressure is harming the brain, heart, eyes or kidneys. In someone over 50, a new headache with a change in vision can mean giant cell arteritis is cutting off the blood supply to the eye (see below): treated the same day, sight can usually be saved, but sight that is lost rarely comes back. Weakness, numbness or drooping of the face, trouble speaking, sudden unsteadiness or a sudden loss of vision can mean a stroke. Double vision, a new drooping eyelid or a change in the size of one pupil can mean pressure on a nerve from a bulging blood vessel (an aneurysm) or a tear in the wall of an artery in the neck (a dissection). A painful red eye with blurred vision and halos can mean a sudden rise in the pressure inside the eye (acute angle-closure glaucoma), which can permanently damage sight if it is not treated quickly. After a head injury, bleeding inside the skull can build up over hours, sometimes after a spell of feeling well. Fever with a stiff neck, or a rash that does not fade when pressed, can mean meningitis. A seizure with a headache needs urgent checks for a cause in the brain. In pregnancy or after a birth, a severe headache can be the first sign of pre-eclampsia, and after a spinal cord injury a pounding headache can be autonomic dysreflexia: both are explained below, and in both, lower readings than 180/120 count. All need urgent treatment. If you have migraine, your usual aura (shimmering or zigzag lines that spread slowly over several minutes and clear within an hour) does not need 000 on its own, and nor do the eye signs of attacks a doctor has already diagnosed as cluster headache (a red, watering eye, a drooping eyelid or a smaller pupil). A first attack, one that is different, or one that comes with a very high reading needs urgent care. In the same way, vomiting in your usual migraine attack does not need 000 on its own; with a very high reading, it does. Remember FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 000.

See your GP the same day if

it is a new headache and you are over 50, especially with a new tender scalp that does not go away, pain in the jaw when you chew that eases when you stop, aching shoulders, or feeling generally unwell; with any change in your vision, see the list above
your blood pressure is still very high (a top number of 180 or more, or a bottom number of 120 or more) when you measure it again, even if the headache has gone and you feel well
the headache is getting steadily worse over days or weeks, or is worst on waking or when lying down, with vomiting or blurred vision
the headache is brought on by coughing, sneezing, laughing or straining, or comes with a whooshing sound in the ears in time with your heartbeat
you have a fever with the headache
you have cancer or a weakened immune system
you are more than 20 weeks pregnant or had a baby in the last 6 weeks and have any new headache, or a reading of 140/90 or more: contact your midwife, maternity unit or GP the same day to have your blood pressure checked; with any of the signs in the list above, go now

Fever can mean an infection. Cancer, a weakened immune system, and pregnancy or a recent birth each make some serious causes more likely, so the bar for checking is lower. A very high reading without symptoms is rarely an emergency, but it needs a doctor that day to start or adjust treatment. The other items are explained further down this page. Attacks of pounding headache with sweating, a racing or pounding heart, or going pale are not usually an emergency (unless you have a spinal cord injury: see the list above), but see your GP about them; if a reading taken during an attack is very high, follow the list above. If you cannot see your GP that day, go to an emergency department. If something matches both lists, follow the 000 list.

Where most people sit

These patterns are uncommon, and most people with high blood pressure never get a headache from it. Even a very high reading usually turns out to have done no harm: in ten Italian emergency departments, about 3 in 4 people who arrived with a top number of 220 or more, or a bottom number of 120 or more, had no damage to the brain, heart or other organs.

If High Blood Pressure Causes Headaches, Why Do Most People With It Feel Nothing?

Your head has been aching since lunch. Someone suggests it might be your blood pressure, so you check it at the pharmacy: 152 over 96. It seems to explain everything. But nearly 4 in 10 Australian adults have high blood pressure, and most of them feel nothing at all: in a national survey, about 6 in 10 people with high blood pressure did not report having it. Like high cholesterol, it is found by measuring, not by how you feel. If high blood pressure caused headaches, why would so many people with it never have one? And why would the headache come and go while the pressure stays up?

The answer is that ordinary high blood pressure does not usually cause headaches. The international classification of headache disorders, the rulebook neurologists use, says that mild (a top number of 140 to 159, or a bottom number of 90 to 99) or moderate (a top number of 160 to 179, or a bottom number of 100 to 109) long-standing high blood pressure does not appear to cause headache; whether moderate high blood pressure makes headaches more likely is still debated. In a Norwegian study that followed 22,685 adults for 11 years, people whose top number was 150 or more were about 30% less likely to report ordinary headaches later than people whose top number was under 140, and later studies of the same Norwegian population found the same: the higher the blood pressure, the fewer the headaches.

Wearing a blood pressure monitor for 24 hours tells the same story. In a Polish study, 150 people with mild to moderate high blood pressure wore a monitor while keeping a headache diary: their blood pressure during headaches was no higher than at other times, and for most of them the day's highest reading came when they had no headache. In a Brazilian study of 76 people, the average reading during a headache was about 139 over 85, against a daily average of about 137 over 83. A headache, in other words, is a poor guide to what your blood pressure is doing.

The reverse holds too: a high reading during a headache is not simply the pain talking. In a Chicago study of 156 people with high readings in an emergency department and no known high blood pressure, about half still had high readings when they measured at home for a week, and neither their pain nor their anxiety in the department explained it. In US emergency department studies, easing a migraine did not bring the blood pressure down with it. So a high reading during a headache needs checking again later, at rest, rather than explaining away.

Where most people sit

Most people with high blood pressure never get a headache from it, and a headache in someone with high blood pressure usually has an ordinary cause, most often tension-type headache or migraine. High blood pressure still matters: over years it raises the risk of stroke, heart attack and kidney disease, and treating it lowers that risk. So have it checked at least every 2 years whether you have headaches or not, and act on a high reading even when you feel well.

When High Blood Pressure Does Cause a Headache

Blood pressure causes a headache in a few particular situations, nearly always when it rises suddenly and steeply.

A sudden steep rise. Doctors call a sudden rise to a top number of 180 or more, or a bottom number of 120 or more, a hypertensive crisis. It can bring on a headache that is usually on both sides and throbbing, sometimes brought on by physical activity, and that eases as the pressure comes down. In an Italian hospital emergency department, headache was the commonest complaint, in about 1 in 5 people (22%), among those with a very high reading but no damage to the organs. Sudden rises can happen when blood pressure medicines are missed or stopped, with some other medicines and recreational drugs, and with the rare conditions below. A very high reading with a headache needs an emergency department (see the list at the top).
When the pressure affects the brain. If very high blood pressure goes on, it can overwhelm the brain's ability to protect itself, and parts of the brain swell (hypertensive encephalopathy). The headache comes with at least two of confusion, drowsiness, problems with eyesight (even blindness) and seizures. It usually happens at 180/120 or more, but in someone whose blood pressure is usually normal it can happen at readings as low as 160/100. On an MRI scan the swelling often shows at the back of the brain, a pattern called PRES (posterior reversible encephalopathy syndrome), which has other causes too. In a series of 113 people with PRES at a US referral hospital, a seizure was the commonest first sign (74%), with headache in about 1 in 4 (26%), confusion in 28% and problems with vision in 20%; with prompt treatment most people recover within days to two weeks. This needs 000.
Pre-eclampsia. From 20 weeks of pregnancy until 6 weeks after the birth, a new or severe headache can be a sign of pre-eclampsia, a condition of high blood pressure in pregnancy that can affect many organs and the baby. The headache is usually on both sides and throbbing, and often worse with activity. Other signs are blurred vision or flashing lights, sudden swelling of the face, hands or feet, pain under the ribs or in the upper tummy, and feeling sick. It can start after the birth, even in women whose blood pressure was normal during the pregnancy: in a US hospital series of 152 women readmitted with pre-eclampsia that began after they had gone home, headache was the commonest symptom (69%), and nearly two-thirds had not been diagnosed with a blood pressure problem during the pregnancy. Untreated, it can lead to seizures (eclampsia). Most headaches in pregnancy and after a birth are ordinary ones, but the bar for checking is low: go to your maternity unit or an emergency department now with any of the signs in the list at the top.
Phaeochromocytoma. A rare tumour, usually of the adrenal gland, which sits on top of the kidney, that releases bursts of adrenaline-like hormones. Its attacks usually bring a severe headache, over in less than 15 minutes in about half of people and in less than an hour in about 7 in 10, with sweating, a pounding or racing heart, going pale and anxiety, sometimes a sense of doom, while the blood pressure rises. Between half and 8 in 10 people with the tumour have these headaches. It is very rare: in a Canadian population study, about 1 in 150,000 people a year was found to have it or a related tumour. Attacks of headache, sweating or a pounding heart are common in people with high blood pressure for ordinary reasons: in a French study of 2,585 people with high blood pressure, 72% had had at least one of the three, and only 6.5% had all three together. A urine or blood test answers the question.
Autonomic dysreflexia. In people with a spinal cord injury at mid-chest level (the sixth thoracic level, T6) or higher, something irritating below the injury, most often a full bladder, a blocked catheter or constipation, can set off a sudden surge in blood pressure, a rise in the top number of 20 to 40 or more above the person's usual reading. Usual readings after these injuries are often low, around 90/60, so a reading that looks ordinary, such as 130/90, can already be high. It brings a sudden, severe, pounding headache, often with sweating and flushing above the injury, a blocked nose and goosebumps. It can be life-threatening, so it is treated as an emergency: sit upright, loosen anything tight, look for the cause (bladder, catheter, bowel, skin), follow your own dysreflexia plan if you have one, and call 000 if it does not settle within a few minutes or you cannot find the cause.

Two dangerous look-alikes also come on suddenly, and both need 000 whatever the blood pressure. Bleeding into the brain usually causes a sudden headache with weakness, numbness or trouble speaking, and it is more likely when blood pressure is high. Reversible cerebral vasoconstriction syndrome, a temporary narrowing of the brain's arteries, causes repeated "thunderclap" headaches, each reaching its worst within a minute, over one to two weeks; they are often set off by sex, exertion, straining or emotion, and at least half of cases follow childbirth or exposure to certain medicines or drugs.

Where most people sit

These situations are uncommon, and some are rare: phaeochromocytoma and autonomic dysreflexia affect very few people. Even a very high reading without symptoms rarely does harm in the short term: in a large US study of people whose reading at a clinic was 180/110 or more and who had no symptoms, fewer than 1 in 100 had a heart attack or stroke in the next 6 months, and sending them to hospital did not change that. A reading that high still needs a doctor that day to start or adjust treatment.

What a High Blood Pressure Headache Feels Like

Usually throbbing, on both sides of the head or all over, often worse with physical activity, and easing as the pressure comes down. It can be felt at the back of the head, but there is no particular place (for pain there, see headache at the back of the head). No feature of the headache proves that blood pressure is the cause: the reading does. Four other headaches are often mistaken for a blood pressure headache, or turn up alongside high blood pressure, and these features help tell them apart.

Swipe the table sideways to compare all five →

Feature	Very high blood pressure	Tension-type headache	Migraine	Sleep apnoea headache	Phaeochromocytoma attacks
Where it hurts	Usually both sides, or all over	Both sides	Often one side, usually the forehead and temple	Usually both sides	Often the forehead or the back of the head
Feels like	Throbbing; can be severe	Pressing or tight, like a band; mild to moderate	Throbbing; moderate to severe	Pressing	Severe; throbbing or constant
How long	Until the pressure comes down	30 minutes to 7 days	4 to 72 hours	Present on waking; gone within 4 hours	Often under 15 minutes; usually under an hour
Activity	Often worse with it, or brought on by it	Not made worse by walking or climbing stairs	Made worse by routine activity	Not typical	Can set off an attack
Other symptoms	Often none; with confusion, problems with eyesight or a seizure, call 000	No nausea; light or noise may bother you a little	Nausea or vomiting, or a dislike of light and noise; sometimes an aura	Loud snoring, pauses in breathing at night, daytime sleepiness	Sweating, a pounding heart, going pale, anxiety
The blood pressure	180/120 or more during the headache	Not the cause	Not the cause, though it can rise during an attack	Often high: sleep apnoea and high blood pressure often go together	Rises steeply during the attack

Where most people sit

The table is a guide, not a diagnosis. Tension-type headache and migraine are the commonest headaches in people with high blood pressure, as in everyone else. If your reading is normal or only a little raised while the headache is there, blood pressure is very unlikely to be the cause, except from 20 weeks of pregnancy, in the 6 weeks after a birth or after a spinal cord injury.

Other Reasons Headaches and High Blood Pressure Turn Up Together

Often the two are linked by something else, or simply happen together because both are common.

Sleep apnoea. Pauses in breathing during sleep, usually with loud snoring and daytime sleepiness, are linked to high blood pressure: in a pooled analysis of 26 studies of 51,623 people, the more severe the sleep apnoea, the stronger the link, and blood pressure was harder to control. About 1 in 3 people with sleep apnoea have morning headaches, although morning headaches are common in people without it too. When sleep apnoea is the cause, the headache is usually on both sides, pressing and gone within 4 hours of waking, and settles once the sleep apnoea is treated. Waking headaches have many other causes, so a sleep study shows whether you have sleep apnoea. See your GP if you snore loudly, stop breathing in your sleep or are sleepy through the day.
Medicines and other substances. Some medicines can cause a headache, usually starting within minutes to hours of a dose and settling within 3 days of stopping, and some raise blood pressure, including some you can buy without a prescription. Recreational stimulant drugs can do both. If a headache began with a new medicine, tell your doctor rather than stopping a prescribed medicine yourself, and ask your pharmacist before taking anything new if you have high blood pressure. Pain relief taken on many days a month can itself cause headaches: see medication overuse headache.
Alcohol. Drinking more than the recommended amount raises blood pressure, and alcohol can bring on headaches. The Australian guideline is no more than 10 standard drinks a week and no more than 4 on any one day.
Giant cell arteritis. After 50, a new headache with a tender scalp (the scalp can also feel tender during a migraine attack; in giant cell arteritis the tenderness is new and does not go away), pain in the jaw muscles when you chew, aching shoulders or feeling generally unwell can be giant cell arteritis, an inflammation of the arteries of the head. It needs your GP the same day for blood tests, because it can affect the eyesight: if your sight blurs, doubles or dims, go to an emergency department now.
Raised pressure inside the head. A different kind of pressure. A headache that is worse lying down or first thing in the morning, sometimes with vomiting or blurred vision, and that gets steadily worse, can mean pressure is building up inside the head, for example from a blockage of the fluid pathways or, rarely, a tumour. Raised pressure of the fluid around the brain without a tumour (idiopathic intracranial hypertension) can also cause a whooshing sound in the ears in time with the heartbeat, and is most common in women of child-bearing age. All need prompt assessment, because some can affect sight.
Cough headache. A headache set off within a second or two of coughing, sneezing, laughing or straining peaks almost at once and usually fades over seconds to minutes. About 4 in 10 cough headaches have an underlying cause, most often a Chiari malformation, where the lowest part of the brain sits lower than usual and crowds the top of the spinal canal, so a cough headache is always worth having checked, usually with an MRI scan. Headaches that come on with hard exercise or during sex are assessed with the same care: see headache after exercise.

Where most people sit

Most people who have both headaches and high blood pressure have two common conditions, not one that explains the other. The right plan treats each: the blood pressure to protect the brain, heart and kidneys, and the headache according to its type.

How to Check Your Blood Pressure When You Have a Headache

A single reading taken in a hurry, or in the middle of a bad headache, can mislead. Take it the way the Heart Foundation advises.

The machine. An automatic machine with a cuff that wraps around your upper arm and fits it properly, of a type that has been tested for accuracy. Ask your pharmacist or GP before you buy one.
Before. No caffeine or smoking for 30 minutes, and measure before eating, taking medicines or vigorous exercise.
Sit quietly for 5 minutes, without talking, with your back supported, both feet flat on the floor, your legs uncrossed, and your upper arm bare and resting on a table.
Take two readings, one minute apart, and write both down.
If a reading is very high (a top number of 180 or more, or a bottom number of 120 or more): with chest or back pain, shortness of breath, vomiting, problems with your eyesight, confusion or a seizure, call 000; with a headache, go to an emergency department or call 000; with no symptoms, see your GP the same day.
To find your usual blood pressure, measure morning and evening for 7 days and take the readings to your GP. Australian guidance leaves out the first day and averages the rest: an average of 135 over 85 or more at home suggests high blood pressure. A monitor worn for 24 hours is another way.
During a headache, a reading is worth taking, and worth repeating once the headache has gone.

How Is a Blood Pressure Headache Diagnosed?

The diagnosis rests on readings taken while the headache is there, and on the headache easing as the pressure comes down. Tests look for the cause and for any harm.

Your story. When the headaches come, what they feel like, any readings you have taken (bring your record or your machine), your medicines, sleep and snoring, and any pregnancy.
The examination. Your blood pressure measured properly, in both arms, your pulses and heart, and a neurological examination including the back of the eyes, where very high blood pressure can leave signs.
Blood and urine tests. To check the kidneys and, when needed, for pre-eclampsia or the hormones of phaeochromocytoma.
Home or 24-hour readings. To find your usual blood pressure (see above).
A sleep study. When snoring, pauses in breathing or daytime sleepiness suggest sleep apnoea.
A brain scan, when it will change what happens next. An MRI scan is needed when the brain may be affected (confusion, problems with eyesight, a seizure or weakness) or the headache was sudden and severe. A normal scan does not show whether blood pressure is causing a headache; the readings do.

A few weeks of a headache diary, with your blood pressure readings alongside, often makes the pattern clear.

How to Get Rid of a High Blood Pressure Headache

A headache caused by blood pressure eases as the pressure comes down. How fast it should come down depends on why it is high.

A very high reading with a headache: get checked first. Follow the lists at the top. Don't take extra blood pressure medicine unless your doctor has told you to: bringing very high blood pressure down too fast can itself be harmful, so unless there is an emergency, doctors usually lower it gradually, over hours to days.
Simple pain relief, used sparingly. For an ordinary headache, simple pain relief helps most people, but ask your pharmacist which kind suits you, because some pain relievers can raise blood pressure. Keep pain relief to two or three days a week at most: see medication overuse headache.
Treating the blood pressure itself. Over weeks, treatment brings the pressure down to a safe level, which protects the brain, heart, eyes and kidneys. It usually means fewer headaches, not more: in a combined analysis of 94 trials of about 24,000 people, headaches were reported by 8% of people taking blood pressure medicines and by 12% of people taking dummy tablets. That suggests lowering blood pressure may prevent some headaches, although the population studies above point the other way, so the question is not fully settled. If a headache begins when you start a new medicine, tell your doctor rather than stopping it yourself.
Lifestyle measures that lower blood pressure. Less salt (under 4 grams a day if you have high blood pressure; most Australians eat about 9), plenty of vegetables, fruit and whole grains, regular physical activity (30 minutes on most days), a healthy weight, not smoking or vaping, and keeping alcohol within the guideline.
Treating sleep apnoea, when it is present, often settles the morning headaches.
Pre-eclampsia, phaeochromocytoma and autonomic dysreflexia each have their own treatment, which deals with the headache too.
Treat the headache according to its type. Most headaches in people with high blood pressure are tension-type headache or migraine, and they are treated as such. Some migraine treatments are not suitable when blood pressure is high, so the plan has to suit both: see our migraine overview.

When to See a Neurologist About Headaches and High Blood Pressure

Headaches that continue once your blood pressure is under control
Headaches on many days a month, or pain relief needed on more than two or three days a week
Migraine with high blood pressure, when the treatment plan has to suit both
A headache that has changed, or a new kind of headache (see your GP first; a new headache after 50 needs your GP the same day)
Morning headaches that continue once sleep apnoea is treated
Attacks of headache with sweating and a pounding heart, after your GP's first tests
You want a clear diagnosis and a plan

A consultation involves a detailed history, a neurological examination and a plan: working out which headache you have, whether blood pressure plays any part, arranging tests when the result will change what happens next, and coordinating with your GP, who usually manages the blood pressure itself. Dr Ron Granot trained at Prince of Wales Hospital, Sydney, and sees patients in Bondi Junction. For the wider picture, read our migraine overview.

Frequently Asked Questions

Can high blood pressure cause headaches? +

Usually not. Mild or moderate high blood pressure that has been there for a while does not appear to cause headaches, and in a Norwegian study that followed 22,685 adults for 11 years, people with a higher top number had fewer ordinary headaches later, not more. High blood pressure can cause a headache when it rises suddenly and steeply, to a top number of 180 or more or a bottom number of 120 or more, when it affects the brain, in pregnancy (pre-eclampsia), and after a spinal cord injury. A very high reading with a headache needs an emergency department, or call 000; call 000 straight away if there is also chest or back pain, shortness of breath, vomiting, problems with your eyesight, confusion or a seizure. A very high reading with no symptoms needs your GP the same day. Lower readings count in pregnancy, after a birth and after a spinal cord injury. From 20 weeks of pregnancy until 6 weeks after a birth, a severe headache, blurred vision or flashing lights, or a reading of 160/110 or more needs your maternity unit or an emergency department now (call 000 for a seizure, trouble breathing or chest pain), and a reading of 140/90 or more needs your midwife, maternity unit or GP the same day. With a spinal cord injury at mid-chest level or higher, a sudden, pounding headache needs you to sit upright, check your bladder, catheter and bowel, and call 000 if it does not settle within a few minutes or you cannot find the cause.

What does a high blood pressure headache feel like? +

Usually throbbing, on both sides of the head or all over, and often worse with physical activity. It comes on with a sudden steep rise in blood pressure, to a top number of 180 or more or a bottom number of 120 or more, and eases as the pressure comes down. Many people expect it at the back of the head; it can be felt there, but there is no particular place. No feature of the headache can tell you it is your blood pressure: only a reading can. If a reading taken after 5 minutes of sitting quietly is that high and you have a headache, go to an emergency department or call 000; call 000 straight away if there is also chest or back pain, shortness of breath, vomiting, problems with your eyesight, confusion or a seizure. Lower readings count in pregnancy, after a birth and after a spinal cord injury. From 20 weeks of pregnancy until 6 weeks after a birth, a severe headache, blurred vision or flashing lights, or a reading of 160/110 or more needs your maternity unit or an emergency department now (call 000 for a seizure, trouble breathing or chest pain), and a reading of 140/90 or more needs your midwife, maternity unit or GP the same day. With a spinal cord injury at mid-chest level or higher, a sudden, pounding headache needs you to sit upright, check your bladder, catheter and bowel, and call 000 if it does not settle within a few minutes or you cannot find the cause.

Should I go to the emergency department for a headache with high blood pressure? +

Yes, if your blood pressure is very high (a top number of 180 or more, or a bottom number of 120 or more) when you measure it again after 5 minutes of sitting quietly, or call 000; call 000 straight away if there is also chest or back pain, shortness of breath, vomiting, problems with your eyesight, confusion or a seizure. Call 000 too for a headache that comes on suddenly and severely and reaches its worst within a minute, or that comes with weakness, numbness or drooping of the face, an arm or a leg, trouble speaking or a loss of vision, whatever your blood pressure. From 20 weeks of pregnancy until 6 weeks after a birth, a severe headache, blurred vision or flashing lights, or a reading of 160/110 or more needs your maternity unit or an emergency department now (call 000 for a seizure, trouble breathing or chest pain), and a reading of 140/90 or more needs your midwife, maternity unit or GP the same day. If you have a spinal cord injury at mid-chest level or higher, a sudden, pounding headache can be autonomic dysreflexia even at a reading that looks ordinary: sit upright with your legs down, loosen anything tight, check your bladder, catheter and bowel, and call 000 if it does not settle within a few minutes or you cannot find the cause. Otherwise, outside pregnancy and spinal cord injury, if the reading is below 180/120, your blood pressure is unlikely to be the cause: see your GP about both. Most people who arrive with a very high reading turn out to have no damage to the brain, heart or other organs, but only tests can show that.

How do you get rid of a headache from high blood pressure? +

By bringing the blood pressure down, with a doctor's help: the headache eases as the pressure falls. First check the reading properly, after 5 minutes of sitting quietly. If it is still very high (a top number of 180 or more, or a bottom number of 120 or more), go to an emergency department or call 000, and call 000 straight away with chest or back pain, shortness of breath, vomiting, problems with your eyesight, confusion or a seizure. Don't take extra blood pressure medicine unless your doctor has told you to: bringing very high blood pressure down too fast can itself be harmful, which is why doctors usually lower it gradually. If the reading is lower, the headache probably has another cause. Lower readings count in pregnancy, after a birth and after a spinal cord injury. From 20 weeks of pregnancy until 6 weeks after a birth, a severe headache, blurred vision or flashing lights, or a reading of 160/110 or more needs your maternity unit or an emergency department now (call 000 for a seizure, trouble breathing or chest pain), and a reading of 140/90 or more needs your midwife, maternity unit or GP the same day. With a spinal cord injury at mid-chest level or higher, a sudden, pounding headache needs you to sit upright, check your bladder, catheter and bowel, and call 000 if it does not settle within a few minutes or you cannot find the cause. Simple pain relief helps most ordinary headaches, but keep it to two or three days a week at most, and ask your pharmacist which kind suits you, because some pain relievers can raise blood pressure.

Can high blood pressure cause a headache every day? +

Rarely. Long-standing high blood pressure does not usually cause headaches, and in studies where people wore a blood pressure monitor for 24 hours, their blood pressure was no higher during headaches than at other times. Daily headaches usually have another cause, such as tension-type headache, migraine, pain relief taken too often (medication overuse headache) or, when the headache is there on waking, sleep apnoea, which often goes with high blood pressure. See your GP, who can check both. A headache that gets steadily worse over days or weeks, or is worst on waking or when lying down with vomiting or blurred vision, needs your GP the same day; a very high reading with a headache needs an emergency department, or call 000.

My blood pressure is normal, but I keep getting headaches. Could it still be my blood pressure? +

Very unlikely. When blood pressure causes a headache, the reading is very high at the time, usually a top number of 180 or more or a bottom number of 120 or more. The exceptions are pregnancy and the weeks after a birth, when pre-eclampsia can cause headaches at lower readings, and a spinal cord injury, where a rise well above your usual pressure can do it. So if your readings are normal when the headache is there, look for another cause with your GP: tension-type headache and migraine are the most common, and a headache diary helps. If you are more than 20 weeks pregnant or had a baby in the last 6 weeks, a severe headache, a headache that does not get better with simple pain relief, blurred vision or flashing lights, sudden swelling of the face, hands or feet, pain under the ribs or in the upper tummy, vomiting with a headache, or a reading of 160/110 or more needs your maternity unit or an emergency department now; call 000 for a seizure, trouble breathing or chest pain. With a spinal cord injury at mid-chest level or higher, a sudden, pounding headache needs you to sit upright and check your bladder, catheter and bowel, and to call 000 if it does not settle within a few minutes or you cannot find the cause.

I'm pregnant or have just had a baby and have a headache. Is it my blood pressure? +

Usually not. Headaches are common in pregnancy, especially in the first months, and after a birth: in a study of 900 new mothers, about 1 in 4 had a headache in the first month, and very few were caused by pre-eclampsia. But from 20 weeks of pregnancy until 6 weeks after the birth, a headache can be the first sign of pre-eclampsia, a condition of high blood pressure in pregnancy that can lead to seizures, and it can start after the birth even if your blood pressure was normal during the pregnancy. Go to your maternity unit or an emergency department now if you have a severe headache, a headache that does not get better with simple pain relief, blurred vision or flashing lights, sudden swelling of the face, hands or feet, pain under the ribs or in the upper tummy, vomiting with a headache, or a reading of 160/110 or more; call 000 for a seizure, trouble breathing or chest pain. For any other new headache, or a reading of 140/90 or more, from 20 weeks of pregnancy to 6 weeks after the birth, contact your midwife, maternity unit or GP the same day to have your blood pressure checked.

Is a headache with high blood pressure a sign of a stroke? +

Usually not. High blood pressure raises the risk of stroke over many years, which is why treating it matters, but a stroke usually shows itself through sudden weakness, numbness or drooping of the face, an arm or a leg, trouble speaking, a loss of vision or sudden unsteadiness, with or without a headache: call 000 straight away. A headache that comes on suddenly and severely and reaches its worst within a minute can mean bleeding in or around the brain, which is more likely when blood pressure is high: call 000. A very high reading (a top number of 180 or more, or a bottom number of 120 or more) with a headache needs an emergency department, or call 000; call 000 straight away if there is also chest or back pain, shortness of breath, vomiting, problems with your eyesight, confusion or a seizure. Lower readings count in pregnancy, after a birth and after a spinal cord injury. From 20 weeks of pregnancy until 6 weeks after a birth, a severe headache, blurred vision or flashing lights, or a reading of 160/110 or more needs your maternity unit or an emergency department now (call 000 for a seizure, trouble breathing or chest pain), and a reading of 140/90 or more needs your midwife, maternity unit or GP the same day. With a spinal cord injury at mid-chest level or higher, a sudden, pounding headache needs you to sit upright, check your bladder, catheter and bowel, and call 000 if it does not settle within a few minutes or you cannot find the cause.

Important: This page is general health information for adults living in Australia and is not a substitute for individual medical advice. If you have a sudden, severe headache that reaches its worst within a minute, a very high blood pressure reading (a top number of 180 or more, or a bottom number of 120 or more) with a headache, chest or back pain, shortness of breath, vomiting, problems with your eyesight, confusion or a seizure, a headache with a stiff neck and fever, a headache with weakness, numbness or drooping of the face, an arm or a leg, sudden loss of vision, double vision, slurred speech or sudden unsteadiness, a painful red eye with blurred vision, or, if you are over 50, a new headache with blurring, double vision or dimming of sight, or any other warning sign listed at the top of this page, call 000 or go to an emergency department. If you are more than 20 weeks pregnant or had a baby in the last 6 weeks and have a severe headache, blurred vision or flashing lights, go to your maternity unit or an emergency department now. Diagnosis and treatment decisions are made on an individual basis with your treating doctor.

Sources: the studies and guidelines behind this page

The international classification of headache disorders (section 10.3, headache attributed to arterial hypertension): Headache Classification Committee of the International Headache Society. Cephalalgia 2018;38:1-211. PubMed 29368949
The national survey: Australian Institute of Health and Welfare, Hypertension in Australia, 2026.
The Norwegian study of 22,685 adults: Hagen K, et al. J Neurol Neurosurg Psychiatry 2002;72:463-6. PubMed 11909904
Later studies of the same Norwegian population: Tronvik E, et al. Neurology 2008;70:1329-36 (PubMed 18413586); Fagernæs CF, et al. Eur J Neurol 2015;22:156-62 (PubMed 25155744).
The Polish study of 150 people wearing 24-hour monitors: Kruszewski P, et al. J Hypertens 2000;18:437-44. PubMed 10779095
The Brazilian study of 76 people: Gus M, et al. Arch Intern Med 2001;161:252-5. PubMed 11176740
The Chicago study of 156 people: Tanabe P, et al. Ann Emerg Med 2008;51:221-9. PubMed 18207606
US emergency department studies of headache and blood pressure: Friedman BW, et al. Am J Emerg Med 2014;32:976-81. PubMed 24993684
The Italian hospital emergency department: Zampaglione B, et al. Hypertension 1996;27:144-7. PubMed 8591878
The ten Italian emergency departments: Pinna G, et al. PLoS One 2014;9:e93542. PubMed 24695800
The large US study of very high readings without symptoms: Patel KK, et al. JAMA Intern Med 2016;176:981-8. PubMed 27294333
PRES: Fugate JE, et al. Mayo Clin Proc 2010;85:427-32 (the 113 people at a US referral hospital; PubMed 20435835); Hinchey J, et al. N Engl J Med 1996;334:494-500 (PubMed 8559202); Lee VH, et al. Arch Neurol 2008;65:205-10 (PubMed 18268188).
Pre-eclampsia that began after going home (the 152 women): Al-Safi Z, et al. Obstet Gynecol 2011;118:1102-7. PubMed 21979459
The study of 900 new mothers: Anzola GP, et al. J Oral Facial Pain Headache 2017;31:346-52. PubMed 29073663
Phaeochromocytoma: Plouin PF, et al. Nouv Presse Med 1981;10:869-72 (the French study of 2,585 people; PubMed 7208288); Leung AA, et al. Eur J Endocrinol 2021;184:19-28 (the Canadian population study; PubMed 33112261).
Sleep apnoea: Hou H, et al. J Glob Health 2018;8:010405 (the pooled analysis of 26 studies; PubMed 29497502); Błaszczyk B, et al. Sleep Med Rev 2024;73:101889 (morning headaches; PubMed 38056382).
The combined analysis of 94 trials: Law M, et al. Circulation 2005;112:2301-6. PubMed 16216977
Australian guidance: Gabb GM, et al. Guideline for the diagnosis and management of hypertension in adults, 2016 (Heart Foundation). Med J Aust 2016;205:85-9 (PubMed 27456450); healthdirect, High blood pressure; Heart Foundation, measuring your blood pressure at home; NHMRC, Australian guidelines to reduce health risks from drinking alcohol, 2020.
Pregnancy: SOMANZ hypertension in pregnancy guideline, 2023; Queensland Health, High blood pressure in pregnancy, 2026; Pregnancy, Birth and Baby.
Spinal cord injury: Queensland Spinal Cord Injuries Service, autonomic dysreflexia, 2026; NSW Agency for Clinical Innovation, 2025; Spinal Cord Injuries Australia.

Headaches and High Blood Pressure?

Book a consultation with Dr Ron Granot — neurologist with a special interest in headache, Bondi Junction. Ask your GP for a referral, then get in touch.

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Call Us02 9388 0615

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Emailreception@eastneurology.com.au

Last reviewed: 17 October 2026 by Dr Ron Granot, FRACP — Consultant Neurologist, East Neurology, Bondi Junction.