Hypertension crisis

[auiu]

Hello.
My mom (57) does have normal blood pressure at the range of 120-80mmhg.But occassionally(maybe once i two months) she does have very strong headaches and the BP levels rises upon 160or 170-10mmhg.
Many cariologist says that she doesnt need to start medication,becouse she have normal bp everyday,others think that she should start them to prevent this hypertension crisis.
What should she do?

P.S also she went to the neurologist,becouse she is a very sensitive person,and has a stressful job,and he described small doses of amytriptiline for a month.Also he said that the headache symptoms are not caused by a migrain.
Thank you !

[auiu]

She meassures 3 times a day the bp leveles(morning,afternoon,night) and the levels are normal...
When she went to the cardiologist,he only meassured th bp level one time(quickly) and the result was i little high 160(as he said),after then when we went home,i meassured her BP and the level was 110mmhg,so i guess probably was the "white coat effect"...

[is_something_wrong]

Hello, I can't tell you if she should because I'm not a healthcare professional.

Yes, amitriptyline is used off label to treat headaches and other types of neurological pain, but it may also have headache as side effect.

I would recommend asking for a 24 hour BP monitoring to see how her blood pressure changes throughout the day. If it is normal, she doesn't need blood pressure treatment. If it is abnormal, (and depending on how abnormal) she may need treatment but her doctor will decide.

In general I would try to trust her cardiologist. They tend to know a lot about blood pressure :-)

[auiu]

But the scan of head was clear.
The neurologyst prescribed the amytriptiline to prevent the headaches...
Should she start using the antihipertensive medication or not?

[is_something_wrong]

First, a hypertensive crisis happens when the blood pressure is extremely high (usually >200 mmHg) and organ damage occur (though not with raised intracranial pressure). A blood pressure of 160-170 systolic is only moderately increased and very unlikely to cause any symptoms at all. Headache is rarely seen as symptom of hypertension in the absence of increased intracranial pressure (which likely manifest with other symptoms as well - malignant hypertension).

Often some condition is causing BOTH symptoms and elevated blood pressure (for example, having a panic attack can cause dizziness and chest pain along with increased blood pressure, but the elevated blood pressure is not causing the symptoms, to use one example).

Another possibility is that the headache (pain) is making blood pressure increase. Pain can often have this effect.

TCAs (like amitriptyline) are known for causing headaches, by the way.

I don't know what to do, but I strongly doubt a blood pressure of 160/100 will cause severe headache. That said, her doctor should find the cause of her headache. And as you probably know, a stressful job is very often causing headache, but I'm not saying this is the reason.