My Dad, 68 Years Old Has A High Blood Pressure

Brief Answer:
Headaches secondary to Valsalva maneuvers

Detailed Answer:
Good morning and thank you for your question on this network. I've read through everything you wrote regarding your father's condition and what I extract from that information is that he is a gentleman who is hypertensive, diabetic, and suffers from gout. He lives in the Great State of XXXXXXX (had a great time when the Neurology Convention was in XXXXXXX a number of years ago....hope they go back there). He had an episode of lowered blood pressure 2 weeks ago to 90/50 which has since resolved but he is now left with a headache that comes on primarily or perhaps even exclusively when he coughs, bends over, or exerts himself.

When a patient of mine complains of these symptoms (as a neurologist) I am concerned about the condition of EPISODIC or INTERMITTENT SECONDARY HEADACHES. An entity called COUGH HEADACHE is described in the classiciation system of headaches we use when trying to figure this type of picture out since the headache is brought on by coughing. Of course, the true underlying mechanism of the headache is believed to be the STRETCHING and sudden VOLUME INCREASE in blood within the head by doing something called a VALSALVA MANEUVER which people do all the time when they strain on the toilet, tighten up their abdominal muscles when they are doing workouts/exercises, or bending over which all tend to INCREASE PRESSURE IN THE HEAD.

What we look for as the REASON for why someone who's never had such a problem to suddenly develop this are things such as aneurysms, arterial venous malformations (AVM's), and fistulas. In other words, we look for entities typically in the head (sometimes in the neck) that with increased pressure of fluid volumes can cause either a bit of bleeding, or by its pressure ADD TO THE pressure that is already being driven up by this VALSALVA MANEUVER, make sense?

And so if I were your father's neurologist I would definitely consider getting a solid HISTORY and doing a complete NEUROLOGICAL examination on him first and foremost to be sure that in fact, he's not "forgetting" about other times he may be having these headaches or doing other things that may make these headaches worse. I would listen for bruits (sounds of turbulent blood flow) on the sides of the neck, base of the neck, and above the orbital ridges.

If things still pan out to a likely diagnosis of SECONDARY HEADACHES precipitated by VALSALVA maneuvers then, I would send him for an MRI and MRA of the brain. I would also image the neck and instruct the radiologist to look for anything in the cavernous sinuses of the head, the carotid sinus region

I would not order the studies with contrast...UNNECESSARY for what you're looking for....and I would definitely ask your father NOW and going forward for the next several weeks to please DOCUMENT the headaches he has throughout the day. Let's find out whether or not they TRULY come on JUST at the time he is doing VALSALVA maneuvers....how long do the headaches last, describe symptoms of the pain (sharp, shooting, gnawing, aching), nausea, vomiting? What does he do to relieve them if they are prolonged....or are they just "in and out?"

Then, you will be much closer to a diagnosis on these new headaches.

BTW, one additional point of interest. Are you aware that a RECALL for certain lots of LOSARTAN were put out by Torrent Pharmaceuticals back in April of this year? Was your father's medication supply affected? Here's some information on that you can look up or ask his doctor..

"Torrent is only recalling lots of losartan-containing products that contain N-Methylnitrosobutyric acid (NMBA) above the acceptable daily intake levels released by the FDA. To date, Torrent Pharmaceuticals Limited has not received any reports of adverse events related to this recall."- April 2019

https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/updated-torrent-pharmaceuticals-limited-expands-voluntary-nationwide-recall-losartan-potassium

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating if you feel so inclined? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 55 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

---

Brief Answer:
Headaches secondary to Valsalva maneuvers

Detailed Answer:
Good morning and thank you for your question on this network. I've read through everything you wrote regarding your father's condition and what I extract from that information is that he is a gentleman who is hypertensive, diabetic, and suffers from gout. He lives in the Great State of XXXXXXX (had a great time when the Neurology Convention was in XXXXXXX a number of years ago....hope they go back there). He had an episode of lowered blood pressure 2 weeks ago to 90/50 which has since resolved but he is now left with a headache that comes on primarily or perhaps even exclusively when he coughs, bends over, or exerts himself.

When a patient of mine complains of these symptoms (as a neurologist) I am concerned about the condition of EPISODIC or INTERMITTENT SECONDARY HEADACHES. An entity called COUGH HEADACHE is described in the classiciation system of headaches we use when trying to figure this type of picture out since the headache is brought on by coughing. Of course, the true underlying mechanism of the headache is believed to be the STRETCHING and sudden VOLUME INCREASE in blood within the head by doing something called a VALSALVA MANEUVER which people do all the time when they strain on the toilet, tighten up their abdominal muscles when they are doing workouts/exercises, or bending over which all tend to INCREASE PRESSURE IN THE HEAD.

What we look for as the REASON for why someone who's never had such a problem to suddenly develop this are things such as aneurysms, arterial venous malformations (AVM's), and fistulas. In other words, we look for entities typically in the head (sometimes in the neck) that with increased pressure of fluid volumes can cause either a bit of bleeding, or by its pressure ADD TO THE pressure that is already being driven up by this VALSALVA MANEUVER, make sense?

And so if I were your father's neurologist I would definitely consider getting a solid HISTORY and doing a complete NEUROLOGICAL examination on him first and foremost to be sure that in fact, he's not "forgetting" about other times he may be having these headaches or doing other things that may make these headaches worse. I would listen for bruits (sounds of turbulent blood flow) on the sides of the neck, base of the neck, and above the orbital ridges.

If things still pan out to a likely diagnosis of SECONDARY HEADACHES precipitated by VALSALVA maneuvers then, I would send him for an MRI and MRA of the brain. I would also image the neck and instruct the radiologist to look for anything in the cavernous sinuses of the head, the carotid sinus region

I would not order the studies with contrast...UNNECESSARY for what you're looking for....and I would definitely ask your father NOW and going forward for the next several weeks to please DOCUMENT the headaches he has throughout the day. Let's find out whether or not they TRULY come on JUST at the time he is doing VALSALVA maneuvers....how long do the headaches last, describe symptoms of the pain (sharp, shooting, gnawing, aching), nausea, vomiting? What does he do to relieve them if they are prolonged....or are they just "in and out?"

Then, you will be much closer to a diagnosis on these new headaches.

BTW, one additional point of interest. Are you aware that a RECALL for certain lots of LOSARTAN were put out by Torrent Pharmaceuticals back in April of this year? Was your father's medication supply affected? Here's some information on that you can look up or ask his doctor..

"Torrent is only recalling lots of losartan-containing products that contain N-Methylnitrosobutyric acid (NMBA) above the acceptable daily intake levels released by the FDA. To date, Torrent Pharmaceuticals Limited has not received any reports of adverse events related to this recall."- April 2019

https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/updated-torrent-pharmaceuticals-limited-expands-voluntary-nationwide-recall-losartan-potassium

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating if you feel so inclined? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 55 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

---

Brief Answer:
Very Good to hear you are aware of an earlier Losartan recall

Detailed Answer:
Thank you for your additional information and also the verification that you are aware that Losartan was in a partial state of recall by the manufacturer but did not related to the particular formulation your dad is taking.

Sometimes details such as that can come into play because ingredients are defective in some way of the medications patients are taking and that leads to secondary effects, etc. In this case that is not likely the case since your dad's medication is not in the affected manufactu4ed lots. However, I will bring this point up for your edification which MAY BE RELEVANT to what's going on and that is that if your dad's symptom of COUGH is relatively NEW and can be traced to when he began taking LOSARTAN then, you and he should know that this is one of the more COMMON SIDE EFFECTS of the medication he is taking and LOW BLOOD PRESSURE is a recognized INTERACTION effect when patients take DOXASOSIN and LOSARTAN at the same time.

HEADACHE is also a recognized side effect considered common when using METFORMIN, FUROSEMIDE, ALLOPURINOL, SIMVASTATIN, and DOXASOSIN.

Truth be told....HEADACHE is a recognized COMMON side effect of virtually EVERY PRESCRIPTION medication on the market in the U.S. as well as abroad. But, I only mention it so that you are aware that if TIMING of these headaches in past few weeks coincides with any recent NEW additions to his medication regimen or link to INCREASING DOSAGES of any of the medications I've listed that have headache as a side effect then, perhaps (as I mentioned in my previous response) these headaches could be present at other times and under other circumstances aside from just when he performs VALSALVA MANEUVERS as you'd indicated initially in your dad's problem description.

Otherwise, I do understand your point that he did have headaches in the past with some of these medications but that they've since gone away.....just bringing back the thought of how many of these drugs can cause HEADACHES and/or other problems that we can all sometimes forget about when new drugs are added to a regimen or dosages are changed.

If the medications are clearly not to be implicated further than this theoretical discussion then, I fall back to the original advice I gave to you about checking him out by getting a NEUROLOGICAL SECOND OPINION for the purpose of ruling out an intracranial process and by getting proper imaging studies of the head and neck to verify that he does not have anything that could account for symptoms.

Once again, if I've provided useful and helpful information to your questions could you consider the possibility of CLOSING THIS QUERY THREAD with a few words of feedback & a 5 STAR rating if the responses are so deserving? Please let me know if any of these investigations are carried out and I'll be happy to OPINE on the results if there are any questions.

You can always me at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 89 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

---

Brief Answer:
Very Good to hear you are aware of an earlier Losartan recall

Detailed Answer:
Thank you for your additional information and also the verification that you are aware that Losartan was in a partial state of recall by the manufacturer but did not related to the particular formulation your dad is taking.

Sometimes details such as that can come into play because ingredients are defective in some way of the medications patients are taking and that leads to secondary effects, etc. In this case that is not likely the case since your dad's medication is not in the affected manufactu4ed lots. However, I will bring this point up for your edification which MAY BE RELEVANT to what's going on and that is that if your dad's symptom of COUGH is relatively NEW and can be traced to when he began taking LOSARTAN then, you and he should know that this is one of the more COMMON SIDE EFFECTS of the medication he is taking and LOW BLOOD PRESSURE is a recognized INTERACTION effect when patients take DOXASOSIN and LOSARTAN at the same time.

HEADACHE is also a recognized side effect considered common when using METFORMIN, FUROSEMIDE, ALLOPURINOL, SIMVASTATIN, and DOXASOSIN.

Truth be told....HEADACHE is a recognized COMMON side effect of virtually EVERY PRESCRIPTION medication on the market in the U.S. as well as abroad. But, I only mention it so that you are aware that if TIMING of these headaches in past few weeks coincides with any recent NEW additions to his medication regimen or link to INCREASING DOSAGES of any of the medications I've listed that have headache as a side effect then, perhaps (as I mentioned in my previous response) these headaches could be present at other times and under other circumstances aside from just when he performs VALSALVA MANEUVERS as you'd indicated initially in your dad's problem description.

Otherwise, I do understand your point that he did have headaches in the past with some of these medications but that they've since gone away.....just bringing back the thought of how many of these drugs can cause HEADACHES and/or other problems that we can all sometimes forget about when new drugs are added to a regimen or dosages are changed.

If the medications are clearly not to be implicated further than this theoretical discussion then, I fall back to the original advice I gave to you about checking him out by getting a NEUROLOGICAL SECOND OPINION for the purpose of ruling out an intracranial process and by getting proper imaging studies of the head and neck to verify that he does not have anything that could account for symptoms.

Once again, if I've provided useful and helpful information to your questions could you consider the possibility of CLOSING THIS QUERY THREAD with a few words of feedback & a 5 STAR rating if the responses are so deserving? Please let me know if any of these investigations are carried out and I'll be happy to OPINE on the results if there are any questions.

You can always me at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 89 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

---