Hesperian Health Guides
Sudden high blood pressure with pounding headache (dysreflexia)
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People with a spinal cord injury above the T6 bone of the spine can get sudden high blood pressure with pounding headaches (dysreflexia). It is the body’s reaction to something that would normally cause pain or discomfort, but which the person does not feel because of the injury. Dysreflexia can be caused when something touches or stimulates an internal organ such as the bowel, genitals, bladder, or intestine, or the skin on the lower body or the breasts.
Common causes of dysreflexia:
- a very full bladder. This can be caused by a catheter that has become bent or twisted.
- a bladder infection, or stones in the bladder or kidneys.
- too much stool in the body, constipation.
- pressure sores, burns, or irritated skin which you may not be able to feel.
- hot or cold temperatures against your skin, such as from lying on a cold examination table
- womb contractions during monthly bleeding or during childbirth.
- sexual activity
Signs of dysreflexia
- sweating, especially from your face, arms, or chest
- reddish or dark blotchy skin above the level of the spinal cord injury
- goose bumps or pimples on arms or chest
- blurry vision or seeing spots
- stuffy nose
- severe, pounding headache
- feeling sick (nausea)
- sudden high blood pressure (up to 240/150)
Any of these problems alone or in combination can be a sign of dysreflexia. If you think you have dysreflexia, you need help right away. Try to have a family member or another caregiver practice how to care for you if you have sudden high blood pressure. You and they must act quickly to remove the cause and lower the blood pressure. You can use this information to let a helper or a health worker know how they can also help if you have dysreflexia.
Treatment for dysreflexia:
- If you are lying down, sit up and stay sitting until the signs have gone away.
- Loosen any tight clothing, including tight socks or stockings.
- If it is caused by pressure or temperature, change your position to remove the pressure or get away from the hot or cold surface.
- Remove anything that is rubbing against the skin.
- Feel the lower belly to see if the bladder is full.
If you cannot pass urine:
- Insert a catheter and empty the bladder.
If you are already using a catheter:
- Are there bends or twists in the catheter? Straighten them so urine can flow.
- Is the catheter blocked? Replace the catheter. Or inject 30 cc of boiled and cooled water (or sterile saline solution) into the catheter to clear the tube.
If you have signs of a urinary infection:
- If this seems to be the cause, inject an anesthetic solution into the bladder through a catheter. Use 10 cc of 1% lidocaine in 20 cc of boiled water. Clamp the catheter for 20 minutes and then release it. The infection also needs to be treated with antibiotics.
If your bowel is full:
- If it has been a long time since passing stool, put some lidocaine jelly on a gloved finger and gently put it in the anus to check if the bowel is full. If it is packed hard with stool, put more lidocaine jelly in the anus. Wait 15 minutes or until the headache becomes less. Then remove the stool with a finger.
If the signs do not go away in 10 minutes, use medicine. Nifedipine will make the blood pressure go down in 5 to 10 minutes.
|Medicines for dysreflexia|
|Medicine||How much to take|
|nifedipine||Bite into and swallow a 10 mg capsule.|
|nifedipine||Crush a 10 mg tablet in a little clean water to make a soft paste and put the paste under the tongue.|
Too much stool or urine in your body can cause dysreflexia. Take care to do your bowel program regularly. Drink a lot of water and eat foods that will help you have easy bowel movements. In addition, make sure to pass urine often. If you use a catheter, make sure it does not become twisted or bent.