CO-44: The paradoxical significance of headache in hypertension.

BACKGROUND: The cardiovascular prognostic value of various types of headache, particularly migraine, in the general population is still controversial. The aim of the present study was to assess this prognostic value for all-cause, cardiovascular and stroke mortalities, in hypertensive patients.

METHODS: 1914 hypertensive individuals were categorized first, according to the absence or the presence of headache and then according to 3 subtypes of headache: migraine, "daily headache" and "other headache". The predictors of headaches at baseline were assessed by multiple logistic regressions. The prognostic value of headache in terms of all-cause, cardiovascular and stroke deaths was first estimated by Kaplan-Meier survival curves (log-rank statistic) according the presence versus absence of headache. The prognostic value of subtypes of headache was represented with Cox Regression curves adjusted for age, while these subgroups have major difference for age. The prognostic value (presence versus absence and subtypes of headache) were also tested by a multivariable cox regression after adjustment for age, sex, systolic BP, diastolic BP, diabetes, total cholesterol, smoking status, MDRD, antihypertensive treatment, previous cardiovascular disease, essential hypertension and body mass index.

RESULTS: Multiple regression analysis demonstrated that all kinds of headache were predicted by gender (women), diastolic blood pressure, absence of diabetes, secondary hypertension and a trend for severe retinopathy. After 30 years of follow-up, we observed 1076 deaths of whom 580 from cardiovascular cause and 97 acute strokes. Kaplan-Meier curves demonstrated a decrease risk of all-cause and cardiovascular mortality for patients with headache (see Figure next page). In a multivariable Cox model adjusted for major confounders, patients having headache had a decreased risk for all-cause mortality (HR 0.82; 95% CI [0.73-0.93]), for cardiovascular mortality (HR 0.80; 95% CI [0.68-0.95]), but not for stroke mortality (HR 1.00; 95% CI [0.70-1.43]). Considering only patients with headache, we observed a better prognostic value for patients with "daily headache" for all-cause and cardiovascular mortality in comparison to those with migraine (HR 0.85; 95% CI [0.65-1.11]; HR 0.78; 95% CI [0.55-1.10] respectively) and "other headache" (HR 0.73; 95% CI [0.61-0.87]; HR 0.73; 95% CI [0.57-0.93] respectively).

CONCLUSIONS: Non-specific headache in hypertensive patients does not seem to convey a negative impact on their prognosis over the long-term. However, they may present a high-risk profile requiring a thorough treatment of their risk factors.