Hello! Thank you for asking on HCM! Regarding your concern, I would explain that your MRI findings indicate a narrowing of the main artery supplying blood to 2/3 of the right cerebral hemisphere. This means that you are at a higher risk for stroke in this artery territory. I would recommend consulting with a neurologist and performing further tests to investigate for the possible cause of this vessel narrowing. This is not a common findings in other persons of your age. Regarding your blood pressure, it does not seem to be caused by the narrowed artery. But I would explain that uncontrolled high blood pressure is a strong risk factor for possible progression of this narrowed vessel. The headache you have seems to be caused by high blood pressure. That is why, I recommend consulting with your attending physician and performing further tests to investigate for secondary causes of high blood pressure (which is not normal at your age too): - a resting ECG - chest X ray study - blood lab tests (complete blood count, fasting glucose, blood lipid profile, PCR, sedimentation rate, kidney and liver function tests, blood electrolytes) - an abdominal ultrasound Besides optimizing your antihypertensive therapy, in order to have a better control of your blood pressure, it would be necessary also avoiding also other cardio-vascular risk factors: - treat dyslipidemia if present - modify your diet (avoid salt and caffeine intake, increase omega 3 fatty acids like fish, fish oil, wallnuts, olive oil, etc.) - avoid smoking or caffeine intake - perform a lot of physical activity. Meanwhile, I would recommend taking acetaminophen or naproxen for the headache. Hope you will find this answer helpful! Kind regards, Dr. Iliri