Background

Hypertension and headache disorders are major contributors to public ill health, linked by a long-standing but questionable belief that hypertension is a conspicuous cause of headache. In Nepal, where hypertension is common and often untreated, we assessed the substance of this belief, hypothesising that, should hypertension be a significant cause of headache, a clear positive association between these disorders would exist.

Methods

In a cross-sectional, nationwide study, trained health workers conducted face-to-face structured interviews, during unannounced home visits, with a representative sample of the Nepalese adult population (18–65 years). They applied standard diagnostic criteria for headache disorders and measured blood pressure digitally. Hypertension was defined as systolic pressure ≥140 and/or diastolic ≥90 mm Hg.

Results

Of 2,100 participants (59.0% female, mean age 36.4 ± 12.8 years), 317 (15.1%) had hypertension (41.0% female) and 1,794 (85.4%) had headache (61.6% female; 728 migraine, 863 tension-type headache, 161 headache on ≥15 days/month [mutually exclusive diagnoses]; 42 unclassified headaches).

All headache collectively was less prevalent among hypertension cases (78.9%) than non-cases (86.6%; p = 0.001). A negative association between hypertension and all headache was demonstrated in bivariate analysis (odds ratio: 0.6 [95% Confidence interval: 0.4–0.8]; p < 0.001), but did not maintain significance in multivariate regression analysis (adjusted odds ratio: 0.8 [95% Confidence interval: 0.5–1.1]; p = 0.09). The findings were reflected, without significance, in each headache type.

Conclusions

If any association exists between hypertension and headache disorders, it is negative. From the public-health perspective, headache disorders and hypertension are unrelated entities: they need distinct policies and programs for prevention, control and management.

中文翻译：

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如果头痛与高血压有任何关联，则为阴性。来自尼泊尔人口研究的证据

背景

高血压和头痛疾病是导致公众健康不佳的主要因素，这与长期以来但有问题的信念有关，即高血压是头痛的一个显着原因。在尼泊尔，高血压很常见且经常未经治疗，我们评估了这种信念的实质，假设如果高血压是头痛的一个重要原因，那么这些疾病之间将存在明显的正相关关系。

方法

在一项横断面的全国性研究中，训练有素的卫生工作者在不事先通知的家访期间对尼泊尔成年人口（18-65 岁）的代表性样本进行了面对面的结构化访谈。他们应用了头痛疾病的标准诊断标准，并以数字方式测量了血压。高血压定义为收缩压≥140 和/或舒张压≥90 mm Hg。

结果

在 2,100 名参与者（59.0% 女性，平均年龄 36.4 ± 12.8 岁）中，317 名（15.1%）患有高血压（41.0% 女性），1,794 名（85.4%）患有头痛（61.6% 女性；728 名偏头痛，863 名紧张型头痛， ≥15 天/月的 161 例头痛[互斥诊断]；42 例未分类的头痛）。

高血压病例（78.9%）中所有头痛的发生率总体低于非病例（86.6%；p = 0.001）。双变量分析显示高血压与所有头痛呈负相关（优势比：0.6 [95% 置信区间：0.4-0.8]；p < 0.001），但在多变量回归分析中未保持显着性（调整优势比：0.8 [ 95% 置信区间：0.5–1.1]；p = 0.09）。这些发现在每种头痛类型中都得到了反映，但没有意义。

结论

如果高血压和头痛疾病之间存在任何关联，则为阴性。从公共卫生的角度来看，头痛和高血压是不相关的实体：它们需要不同的预防、控制和管理政策和计划。