High-Pressure Headache: Causes, Symptoms, and Treatments

High-pressure headache, also known as pseudotumor cerebri or idiopathic intracranial hypertension (IIH), are caused by increased cerebrospinal fluid (CSF) pressure around the brain.

This condition can mimic other headache disorders, including migraine, and understanding its symptoms, causes, and treatment options is crucial for effective management.

What is a High-Pressure Headache?

A high-pressure headache occurs when there is an elevated level of cerebrospinal fluid (CSF) around the brain, leading to increased pressure inside the skull. CSF normally cushions the brain and spinal cord, providing essential nutrients and removing waste. When pressure becomes too high, it can lead to headache and other neurological symptoms.

  • Definition: Also known as pseudotumor cerebri or idiopathic intracranial hypertension, high-pressure headache is characterized by symptoms that worsen when lying down and improve when standing up.
  • Key Differences from Low-Pressure Headache: Unlike low-pressure headache, which improves when lying down, high-pressure headache is often worse in this position and may also worsen with activities that increase pressure, such as coughing, sneezing, or bearing down.

Causes of High-Pressure Headache

Several factors can lead to high-pressure headache, including:

  • Demographics: More common in women than men and in individuals who are overweight.
  • Medications: Certain medications, such as tetracycline antibiotics (e.g., doxycycline or minocycline), can cause high-pressure headache. Overuse of vitamin A supplements can also contribute.
  • Underlying Conditions: Some medical conditions, like Cushing’s disease, kidney failure, and syndromes associated with high cortisol or aldosterone levels, can increase the risk.

Symptoms of High-Pressure Headache

High-pressure headache can present with a range of symptoms, including:

  • Headache Location: Pain is often located at the back of the head or behind the eyes.
  • Mimic Migraine Symptoms: This headache type can have migraine-like characteristics, including sensitivity to light and noise, nausea, and moderate to severe pain.
  • Worsening Symptoms: Headache may worsen when lying down, with physical exertion, or during weather changes (e.g., before rain or thunderstorms).
  • Visual Disturbances: Blurred vision, temporary visual loss, or other visual disturbances can occur. Left untreated, high-pressure headache can lead to permanent vision loss.

Diagnosis of High-Pressure Headache

To diagnose a high-pressure headache, healthcare providers typically follow these steps:

  • Eye Examination: Using an ophthalmoscope to check for swelling of the optic nerve at the back of the eye, which can indicate elevated intracranial pressure.
  • Brain Imaging: An MRI or CT scan of the brain is used to rule out other causes of elevated pressure, such as tumors.
  • Spinal Tap: A lumbar puncture is performed to measure CSF pressure. A pressure reading greater than 25 cm H₂O in adults can confirm the diagnosis.

Treatment Options for High-Pressure Headache

There are several treatment options for managing high-pressure headache:

Medications:

  • Diuretics: Water pills like acetazolamide (Diamox) or furosemide (Lasix) help reduce fluid buildup and lower CSF pressure.
    • Side Effects: Medications may cause side effects like tingling in fingers or kidney stones.
  •  

Surgical Interventions:

  • Shunt Placement: A tube is surgically placed to drain excess CSF from the brain to the abdominal cavity or heart, helping relieve pressure.
  • Stent Placement: In some cases, a small metal cylinder is inserted in veins to improve CSF drainage, although its use remains controversial in headache management.

When To Talk With a Healthcare Provider​

You should consult a healthcare provider if you experience:

  • Persistent headache that worsens when lying down or with physical exertion.
  • Visual disturbances, such as blurred vision or temporary loss of vision.
  • Symptoms unresponsive to standard migraine treatments or worsening despite ongoing management.

This resource is based on HeadWise Episode 8, High Pressure Headache with Vince Martin, MD.
Published, 04/03/2019

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