Brief Answer:
the cause of the headaches has to be identified

Detailed Answer:
Hello,

I've read your text... your case sounds a little complex. I believe we should focus on the headaches first. Do you have the headache all day or does it come and go? Are there pain-free periods during the day? Is there anything that provokes the headache or makes it worse or better? Do you have other symptoms when you have headaches? Does this nausea accompany the headache or is it irrelevant? How intense is the headache and how fast did it start? Was it like a hammer blow (abrupt very intense headache) ? Do you have fever?

The high blood pressure may sometimes be caused by pain. Painful stimuli raise the blood pressure and when the pain subsides so does the high blood pressure. So one thing to check is whether your blood pressure is low when the pain is gone (if it is).

Another thing to notice is that fludrocortisone should be stopped gradually. The dose should be tapered over a few weeks.

If this blood pressure elevation is not related to the pain then there are 3 scenarios that sound realistic in a case like yours:
- blood pressure raised due to the mineralocorticoid effects of fludrocortisone
- blood pressure raised due to renal artery stenosis
- a new stroke despite the lack of serious neurological symptoms

In a patient like you I would have started from the headache issue. A CT scan of the brain would exclude hemorrhage and would detect some non-hemorrhagic cases of stroke. The CT-scan would be particularly useful if your doctor detects neurological deficits on clinical examination.

Then the blood pressure can be checked closely for at least a week and perhaps also do a 24-hour Holter measurement.

If your blood pressure is consistently high the fludrocortisone should be gradually tapered and an antihypertensive medication initiated.

I can't be more specific than that (like suggest medications ,etc) because I'm not your doctor. Your doctor knows your complete medical history, has seen your test reports and can examine you, so your doctor is the most appropriate person to suggest treatment.

I hope you find my comments helpful!
Kind Regards!

---

Brief Answer:
your headache is a little worrisome

Detailed Answer:
You're welcome!

Any headache that wakes the patient (actually any symptom) requires investigation. The investigation should start with a CT scan of the brain.
If the brain is OK then other secondary causes of hypertension would have to be excluded like pheochromocytoma (which may cause headache, orthostatic hypotension, hypertensive crisis, a loud heartbeat, etc). Renal artery stenosis means the narrowing of the lumen of the arteries that bring blood to the kidneys. When the kidneys receive less blood than they expected, they raise the blood pressure. Renal artery stenosis may occur due to atherosclerosis in older individuals. Other causes may apply for younger patients.

It's a good idea to discuss your headaches with the neurologist!

Best wishes!

---