Symptoms in hypertension: Diagnostic challenges, clinical implications and management strategies for headache, dizziness and vertigo.

Headache, dizziness and vertigo are non-specific but frequently reported symptoms in patients with hypertension. When evaluating headache, clinicians must systematically exclude primary headache disorders - such as migraine, tension-type headache and trigeminal autonomic cephalalgias - before attributing symptoms to hypertension. If a primary headache is suspected, referral to a neurologist is essential for specialized management. Hypertension-related headache must fulfil specific diagnostic criteria, including a high blood pressure level (≥180/120mmHg), a demonstrated causal relationship through temporal association and symptom relief following antihypertensive treatment. Whereas severe hypertension combined with headache (e.g. malignant or accelerated hypertension, grade 3 or 4 hypertensive retinopathy) requires urgent attention, the long-term prognosis of patients with recurrent symptoms does not appear to be negatively impacted. Dizziness, often described as lightheadedness, unsteadiness or a floating sensation, must be distinguished from vertigo, which is characterized by an illusion of movement, typically rotatory. In patients with hypertension, vertigo necessitates a thorough evaluation to rule out neurological and vestibular aetiologies, in collaboration with neurologists and ear, nose and throat specialists. These patients require meticulous blood pressure monitoring because of their increased risk of cardiovascular death, particularly from stroke.