Suggest Remedies For Morning Headache In A Stage 2 Hypertension

Posted on Fri, 1 Jul 2016

Question: I have stage 2 hypertension morning average pressures 170/72/65, night pressures average 156/68/62, my present medications for 2 weeks 0.3 clonidine/2.5 minoxidil/10mg amlodipine x2/20mg lisonipril hctz x 2 after 7 days have started having medium headaches beginning about 3 hours after morning meds, I take meds 7 am/7 pm plus/minus. I have been on amlodipine/lisonipril for 16 days, my averages were developed over the last 7 days, help, help

Answered by Dr. Ilir Sharka (59 minutes later)

Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome back on HCM!

Your morning headaches could be related to high blood pressure (170mmHg indicates uncontrolled high blood pressure and could be the cause of headache) or adverse effects related to amlodipine or hydroclorthyazide.

You should know that amlodipine (as other calcium channel blockers), is known to cause headache as an adverse effect encountered up to 8% of the patients.

I carefully passed through your question and I would like to know more precisely the doses of your morning medicine and in the afternoon. I must admit that I do not understand entirely your doses. Do you take amlodipine only in the morning or twice daily?

From the other hand Hydroclorothyazide is another drug which can cause headache as an adverse effect in up to 5% of the patients. Do you take it only in the morning or in twice daily? Have you made any change to hydroclorothyazide doses lately?

What are your blood pressure values during headache episodes? How long does this headache last? Have you monitored your blood pressure during these hours and after them?

This is really important to determine if your headaches are caused by uncontrolled high blood pressure or are an adverse effect related to your actual therapy.

If your headaches are not connected to episodes of high blood pressure, than further changes to your therapy should be done, because it would indicate possible intolerance related to adverse effects of your actual antihypertensive drugs.

Hope to have been helpful!

I am at your disposal for further questions whenever you need!

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (20 hours later)

if possible please provide me with an email address so that I can have my information typed by my secretary, it will be quite lengthy and there may not be enough characters available here to give you full information, in the event you cannot do that I will do it here................cheers

Answered by Dr. Ilir Sharka (4 hours later)

Brief Answer:
My answer as follows:

Detailed Answer:
Hello again!

I would like to explain that on this site it is not usually allowed to communicate by email.

There is not a limitation of the characters that you can write.

You can ask your secretary to write your information on a Word document and than copy-paste by clicking inside this case. It is quite simple!

I would be happy to review all your tests and medical information.

Regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (2 hours later)

THANK U FOR A PROMPT REPLY, i will forego the long drawn out message, my medications since may 17 have been, 0,3 mg clonidine, 2.5 mg minoxidil, 10 mg lisinipril and 5 mg amlodipine all 7 am and 7 pm, plus 25 mg hydroclorothazide 1 time in the morning my pressures have averaged over 5 days, systolic 170/72/65 in the morning and 156/68/62 at night. 4 days ago I started having a dull headache about 11 am, it must be either lisonipril or amlodipine because I have never had a headache that I can remember and I have been on clonidine/minoxidil,divan/fourosimide for several years, have also had blood pressures in these ranges from time to time, last night and this morning I eliminated the lisonipril and substituted 160/12.5 valsartan and today have not had the headache. I would like to get my systolic pressure to XXXXXXX out at no more than 150, I feel better when it is between 130/150, I also dropped the 25 mg hydroclorazide since 25 mg is the maximum, I also do not have excessive swelling, I have tried to adjust in accordance with your prior suggestions, what suggestions can u provide me now, coach?

Answered by Dr. Ilir Sharka (8 hours later)

Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

Thank you for the additional information.

It seems that lisinopril is the cause of your headache, based on the fact that switching to valsartan has eliminated your headache.

I would recommend continuing valsartan intake, as it seems that you tolerate it well.

I would also recommend some lifestyle modifications in order to help you manage your blood pressure better:

-avoid salt and caffeine intake
- perform a lot of physical activity
- reduce your weight if you are overweight.

Regarding hydroclorothyazide, I would recommend increasing the dose to 25mg, as it is a normal dose.

You can try to take 2 tab of valsartan in the morning, in order to have a better control of your blood pressure, and achieved the desired blood pressure values.

Hope to have been helpful!

Regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (10 hours later)

my meds were taken at 7 AM today, my systolic pressure was 177, it is now 11 AM and my systolic pressure is now 142, however it will continue to rise up to 170 plus or minus, do you think the valsartan 160 mg x 2 in the morning and the 25mg hydroclorathizide taken in the morning will have an all day effect?, it appears to me that without time release medications I may never solve my systolic pressures, I would also like to get off both clonidine and minoxidil since both are antique medications and don't have that much effect on me except the clonidine will drop my systolic pressure 20/30 points in 3 hours, then it immediately starts up again, what would be the next go to medication in the event it is necessary after deleting the clonidine and minoxidil? I appreciate your advise very much,,,,,, XXXXXXX WARD

Answered by Dr. Ilir Sharka (5 hours later)

Brief Answer:
I would explain as follows:

Detailed Answer:
Dear XXXXXXX

I understand your concern and would explain that valsartan/hydroclorothyazide is a slow release medication as it has a long half life (the time that our body needs to metabolize the drug). It will certainly help reduce your blood pressure values throughout the day.

Regarding clonidine, I would recommend reducing gradually the doses until stopping it, as it doesn't seem to be very effective in your clinical situation.

Doubling the dose of valsartan/hydroclorothyazide will help maintain normal blood pressure during clonidine withdrawal.

I would not recommend reducing the doses of minoxidil for the moment. It is important to make gradual therapy changes (one drug at a time), in order to avoid possible exacerbations of high blood pressure.

Hope to have been helpful!

Best wishes,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (15 hours later)

thanks again for your wisdom, at 7 pm last night I decided to try something different, since valsartan seems to be a good medication for me I decided to take 2 each 160 mg valsartan 1 10 mg amlodipine 2.5 minoxidil and 0.3 clonidine since my pressures are so high overnight and guess what? this morning my systolic pressure was 152, I don't recall it being that low in the morning since I don't know when, this morning at 7 am, since the limit of valsartan is 320 mg per day I took 20 mg amlodipine,25 mg hydroclorothazide, 2.5 minoxidil, and 0.3 clonidine and today I will see what happens. it seems to me that I may need an additional medication in the valsartan family to take in the morning if the meds for today don't work, tonight I will eliminate the amlodipine since the limit is 20 mg per day, thanks again, XXXXXXX WARD

Answered by Dr. Ilir Sharka (1 hour later)

Brief Answer:
I would recommend as follows:

Detailed Answer:
Dear XXXXXXX

I understand that valsartan is helpful in managing your blood pressure, but I would not recommend making other changes to your actual therapy. These changes are a little confusing if made all at the same time. As I explained before, increasing the doses of medications taken in the evening can help reduce morning blood pressure values.

I would recommend taking valsartan 160mg twice daily, Hydroclorothyazide 25mg in the morning and amlodipine 10mg twice daily, besides clonidine and minoxidil as before.

I recommend continuing with this schema of medication for at least 3-4 days and closely monitor your blood pressure. You should write down your blood pressure values.

Let me know about your situation.

Hope to have been helpful!

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (2 days later)

thank u again for your recomendations, did I understand correctly that I should take 10 mg amlodipine twice daily? I thought that 10 mg was the maximum daily intake, I have followed your other advice but my systolic pressure at 7 am today was 178,it is now 9.30 am and its 129, however it starts rising from here and but usually drops to 150/160 by 7 pm tonight, I monitor and record my pressures a minimum of 7 am/1 pm/7 pm. my diastolic is always below 70, however my heartrate is always low possibly due to medications, hardly ever gets to 60.........hope I did not confuse u with my rambling, thanks......... XXXXXXX Ward

Answered by Dr. Ilir Sharka (6 hours later)

Brief Answer:
My answer as follows:

Detailed Answer:
Hello again XXXXXXX

Yes, you are right: Amlodipine can be given up to a XXXXXXX dose of 10mg per day. I would recommend taking it in the evening (10mg), in order to help you reduce your morning blood pressure values. ( I am sorry to have confounded you before, just a mistake while writing)

I understand that your blood pressure is not stable, but as I already explained it is better be patient and wait until making the next changes to your therapy.

We should do one change at a time and wait for some days, in order to see the real changes in your blood pressure (it takes some days up to a week in order to achieve a new balance of blood pressure after every change to the anti-hypertensive therapy).

I am always here to help you make the proper therapy adjustments.

Greetings!

Dr. Iliri

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar