Retinal Vessels as a Target Organ in Hypertension Secondary Stroke Prevention in Hypertensive Patients: The Impact of the MOSES Study

By Albert Yeung Types of Headache in Hypertensive Individuals More than 90% of people experience headache of some kind at least once in their lifetime. Many patients and physicians still believe headache to be a common symptom of hypertension. Pathophysiologically, a headache arises when the primary afferent fibers that innervate the meningeal or cerebral blood vessels are activated; most of these nociceptive fibers are located within the first division of the trigeminal ganglia or upper cervical ganglia. Although patients with secondary headache disorders have, by definition, an identifiable structural or inflammatory source, most chronic headaches are primary headache disorders such as migraine or tension headache. The prevalence of migraine and tension headaches, the most common cause of chronic headache, in the hypertensive population at large is not known. Migraine, a disorder of neurovascular regulation with a central nervous system generator, is broadly categorized as migraine without an aura (85%) and migraine with an aura (i.e., classic migraine, affecting 15% of patients). Differentiation between a primary and secondary headache disorder often necessitates a detailed history, particularly since an individual patient can suffer from different types of headaches. To determine whether headache in a hypertensive patient is due to elevated blood pressure (BP) and not to other causes of headache can be a time-consuming and challenging task. Migraine is more prevalent in younger adults, whereas hypertension increases with age. Since hypertension and migraine headaches are both common disorders affecting 10% to 22% of the adult population, one can expect up to 3% of the population to have both conditions.