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Early morning hypertension/headaches

PMR/GCA since May 2015, presently treated with Prednisone 35mg, which I take with breakfast, and Acterma IV infusion monthly. I was in an auto accident January 2, 2016 and sustained a whiplash. I'm having physical therapy to help with whiplash, especially painful in upper back, neck, shoulders. Migraines and headaches have increased since auto accident. Had MRI done since accident, which was normal. Almost every morning between 3-5am, I wake up with heart pounding, sometimes severe headache, sometimes no headache. This week, I have checked my blood pressure when these symptoms occur. It is always elevated. This morning it is 177/103, pulse 90 when sitting, and 151/93 pulse 97 when standing. My primary care doctor and rheumatologist know I have orthostatic hypotension. The physical therapist encouraged me to stabilize my head with pillows before going to sleep in case I position my head in a weird position during the night. I also have TMJ, and my dentist is going to make an orthotic appliance to wear at night. Has anyone experienced an elevated blood pressure at night? Early on since I was diagnosed with PMR/GCA, I had palpitations. I had a 24 hour halter monitor which came back normal. Thanks for any suggestions or your experiences.

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In the early stages of PMR I had palpitations - but not on a regular basis and only for a short period at any time. Much later I had a severe reaction to an infusion of diazepam for back muscle problems - I developed atrial fibrillation but at least I was in hospital! Once that was sorted out with medication I realised those old episodes have stopped. They were almost certainly a/f.

Did you have an episode of palpitations during the holter monitor? If you didn't - yes, it could come back "normal". My GP said originally that I should call the emergency services if I had an episode - rather OTT I thought but it is logical. If they don't last long then you may never get to a doctor while it is happening. I take it you are in the US but I assume they arrive with an ECG machine? They do in the UK. Which means there is a better chance of seeing what is going on in the trace.

If your BP is so high in the mornings, then you need a 24 hour holter BP monitor - fun but it isn't anything like as bad as I expected overnight! I had one last week so haven't had the results back. My spiking BP (measured myself) was during the morning and I had dizzy spells. We've rearranged the medication and it seems better - but more to the point I've identified a PMR flare and I think it was associated. And frankly - you need a cardiologist not a GP! As far as I know there are longer period monitors than the 24 hour ones - and if it is intermittent then that is what you will need if you can't get a paramedic to call by at the right time!



Thank you for your counsel and your experience. I had my IV infusion of Acterma today and was able to talk with the nurses there about my BP and palpitations. We discussed other symptoms as well. They strongly encouraged me to talk with my doctor to have a fasting glucose panel, as I have only had one non fasting glucose last October. I have sent a message to my doctor and add that to my next lab tests ASAP.

Thanks for your response.



Sorry to hear about your accident and subsequent problems. I also was diagnosed June last year PRM/GCA, was previously diagnosed with TMJ but Rheumy says it was symptoms of the GCA. I did wear a guard in my mouth for almost 2 years, which made no difference to my discomfort at all. I had one for the top teeth and then we tried one for the bottom, but to no avail. The preds have stopped the pain.

Best wishes.



Thank you for your response to my post. I am glad the Prednisone did help your TMJ or GCA pain. I have some jaw, joint, and bite issues that are possibly increasing the severity of the headaches as well. I had braces as a young girl, but the jaw structure was not taken in to account at that time, just straightening of the teeth. It's all very frustrating and difficult to sort through what is causing what. One step at a time.

Thanks again.


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I had an upper wisdom tooth removed a couple of years ago - and it seems to have sorted out some long term back muscle problems that had been causing some really bad neck problems and which made the whole PMR thing even worse. The tooth was affecting my bite, and that was putting stress onto my back muscles which eventually went into meltdown. Maybe a dental check could help - but some dentists are more aware than others?


Hi PMR/pro:

Yes, I have been seeing my dentist. She is really tuned in to the whole body when it comes to dental problems. I'm undergoing treatment for a crown right now. After that, she is going to begin the evaluation for a mouth retainer for the TMJ, but especially my bite. I have an extremely small mouth, so have had to have teeth removed as a child. Went through 2-3 years of braces and retainers. We are hoping this mouth appliance will help. My physical therapist also does therapy for people with TMJ problems. I can only handle one major issue at a time. Physical and emotional stress have been at an all time high. I am so thankful for you and all the others here.


Perhaps you could request a seven day monitor; I had to do this to get my SVT diagnosed.


I bought a Kardia home ECG and I'm hoping that this gives the results I already know my 24 hour bp and 48 hour heart rate tests will not have given because for me and many others it's most often the case that all our distressing and ofttimes painful symptoms bugger off the second a doctor appears!

I've also coupled this with clinically validated blood pressure upper arm cuff so I can take them in with me (if my heart doesn't give up by then) to my cardiologist appointment sometime in the distant future to say please can I have a week long testing kit to show that this is deadly real.

Feeling glum as my bp is often 200+/100+ and it's now becoming the norm unless I'm anywhere near a doctor that is!

Good health to y'all xx


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