Hesperian Health Guides

Dysreflexia (Sudden High Blood Pressure with Pounding Headaches)

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HealthWiki > Disabled Village Children > Chapter 23: Spinal Cord Injury > Dysreflexia (Sudden High Blood Pressure with Pounding Headaches)

Persons with quadriplegia or very high paraplegia run the risk of ‘dysreflexia’—or sudden, dangerous increase in blood pressure with severe pounding headaches.

Dysreflexia is the body’s reaction to something that would normally cause pain or irritation, but which the person does not feel because of the spinal cord injury.

  • bladder problems—especially when the bladder is too full, infected, or has bladder stones (This is by far the most common cause.)
  • stretching of the bowel—from constipation, with a big ball of hard shit, or from finger pressure to remove the shit
  • pressure areas or sores—or even irritation from lying on a small object without knowing it
  • burns
  • spasm of the womb—especially just before or in the first days
    of a woman’s monthly period, or during childbirth
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  • severe pounding headache
  • sweating of the head
  • stuffy nose
  • reddish skin patches on face and neck
  • goose pimples above the level of injury
  • slow pulse
  • high blood pressure (up to 240/150)

Dysreflexia is a medical emergency. The high blood pressure could cause seizures or deadly bleeding inside the brain.

What to do

Act quickly to remove the cause and lower the blood pressure.


Quickly lower the blood pressure in the head.
♦ If lying, sit up; stay sitting until the signs go away.

♦ Change position, drop feet down, loosen belt or straps, remove tight stockings.
2. Look for the cause of dysreflexia, and remove it if possible.
Bladder. Feel the lower belly to see if the bladder is full. If a catheter is in place, check for bends or kinks and straighten them to let urine flow. If the catheter is stopped up, open it by injecting 30 cc. of boiled and cooled water (or sterile saline solution) into the catheter. Or take the catheter out. If a catheter is not in place and the person cannot pee, put in a catheter and empty the bladder (see "How to Put in a Catheter").
♦ If a urinary infection appears to be the cause, inject an anesthetic solution into the bladder through a catheter. Use 10 cc. 1% lidocaine in 20 cc. of boiled water. Clamp the catheter for 20 minutes and then release. Treat the infection.
Bowel. If the bladder does not seem to be the cause, check for a full bowel. How long has it been since the last bowel movement (shit)? Put some lidocaine (Xylocaine) jelly on your finger and check if the bowel is packed with hard shit. If it is, put in more lidocaine jelly. Wait 15 minutes, or until the headache becomes less. Then gently remove the shit with your finger.
Pressure. Change the child’s position in order to relieve pressure over bony areas. (Sometimes just staying in the same position too long can bring on dysreflexia.)
3. If the signs do not go away, get medical help as fast as possible.
4. If the child has frequent or severe periods of dysreflexia, or you cannot find the cause, try to have him seen by a specialist on spinal cord injury, and possibly a ‘urologist’ (specialist of the urine system).

Suggestion: For quadriplegics in villages, it is wise to have injectable 1% lidocaine (Xylocaine) and lidocaine gel available for dysreflexia emergencies.

This page was updated:21 Nov 2019