A high pressure headache is a distinct type of headache resulting from increased pressure inside the skull, which can be a sign of underlying conditions. This type of headache differs from common headaches, such as tension headaches or migraines, due to its direct link to the pressure within the brain’s confines.
What is a High Pressure Headache
A high pressure headache is directly associated with elevated intracranial pressure (ICP), which is the pressure exerted by fluids within the skull, primarily cerebrospinal fluid (CSF) and blood, on the brain tissue. CSF is a clear fluid that surrounds and cushions the brain and spinal cord, providing nutrients and removing waste products. The skull is a rigid compartment containing the brain, CSF, and blood, and any increase in the volume of one component without a corresponding decrease in others can lead to elevated ICP.
Normal ICP in adults typically ranges from 7 to 15 mmHg when lying flat. When this pressure rises significantly, generally above 20 mmHg, it can cause a high pressure headache. Unlike low pressure headaches, which often improve when lying down, high pressure headaches tend to worsen in this position.
Identifying the Symptoms
High pressure headaches present with a range of symptoms. The headache itself is often described as throbbing or pulsating, and it commonly originates at the back of the head or behind the eyes. The pain frequently worsens in the morning or upon waking, and it can also intensify with activities like coughing, sneezing, or bending down.
Beyond the headache, individuals may experience visual disturbances, such as blurred vision, temporary vision dimming, or double vision. Swelling of the optic nerve, known as papilledema, can occur due to the increased pressure on the nerve that connects the eye to the brain, and this can lead to a reduced visual field or even permanent vision loss if left untreated. Other common symptoms include nausea, vomiting, and dizziness. Some people also report pulsatile tinnitus, which is a whooshing or rhythmic noise in the ears that synchronizes with their heartbeat.
Common Causes
Increased intracranial pressure, leading to high pressure headaches, can stem from various medical conditions and factors. One common cause is idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, where the pressure inside the skull increases without a clear underlying reason. IIH is more common in women of childbearing age, particularly those who are obese, and it is thought to be related to an imbalance in the production or absorption of cerebrospinal fluid.
Brain tumors can also contribute to elevated ICP by occupying space within the skull, leading to pressure on brain tissue. Hydrocephalus, a condition characterized by an abnormal accumulation of CSF within the brain’s ventricles, is another significant cause. This buildup can result from blockages in CSF flow, issues with reabsorption, or, less commonly, increased CSF production.
Cerebral venous sinus thrombosis (CVST), a rare condition involving blood clots in the veins that drain blood from the brain, can also lead to increased intracranial pressure. These clots obstruct blood flow, causing blood to accumulate and increasing pressure within the skull. Infections of the central nervous system, such as meningitis (inflammation of the membranes surrounding the brain and spinal cord) and encephalitis (inflammation of the brain), can also cause elevated ICP due to swelling and inflammation. Certain medications have been linked to secondary intracranial hypertension, including tetracycline antibiotics, excessive vitamin A, growth hormone, and some steroids.
Diagnosis and Management
Diagnosing high pressure headaches involves identifying the underlying cause of elevated intracranial pressure. A neurological examination is typically performed to assess senses, balance, and mental status. Doctors may also look into the eye with an ophthalmoscope to check for papilledema, which is swelling of the optic disc. Imaging tests, such as a CT scan or MRI of the brain, are important to rule out structural issues like tumors, bleeding, or hydrocephalus. An MRI is often preferred for detecting subtle changes in brain tissue.
A lumbar puncture, also known as a spinal tap, is frequently performed to directly measure the cerebrospinal fluid pressure and to analyze the fluid’s composition. This procedure provides a snapshot of the pressure, but continuous monitoring over 24 hours or more may be used in certain cases to observe pressure changes over time and with different body positions.
Management strategies for high pressure headaches focus on reducing intracranial pressure and addressing the underlying cause. Medical treatments often include diuretics, such as acetazolamide or furosemide, which help the body reduce CSF production or remove excess fluid. Mannitol, an osmotic diuretic, is also used to pull water from brain tissue into the bloodstream, thereby reducing swelling and pressure.
Lifestyle modifications, such as weight loss, are recommended for conditions like idiopathic intracranial hypertension, as obesity is a significant risk factor. In severe cases or when medication is not effective, surgical interventions may be considered. These can include shunt surgery, where a thin tube is inserted to drain excess CSF to another part of the body, or optic nerve sheath fenestration, a procedure to relieve pressure on the optic nerve.
When to Consult a Doctor
Prompt medical attention for headaches is important, especially when certain symptoms are present. If a headache is persistent, worsening, or accompanied by changes in vision such as blurred or double vision, or temporary loss of sight, a doctor should be consulted immediately. Severe nausea and vomiting, particularly when not clearly linked to other common illnesses, also warrant medical evaluation.
Neurological symptoms like confusion, weakness, numbness, difficulty speaking, or problems with balance or coordination alongside a headache are serious indicators that require urgent professional assessment. Headaches that come on suddenly and are described as the “worst headache of your life” should also prompt immediate medical care. High pressure headaches can be a sign of serious underlying medical conditions that require timely diagnosis and treatment to prevent complications, including permanent vision loss.