Headache caused by increased or decreased intracranial pressure

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The article was professionally consulted by a Doctor of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital
Headaches not only affect the patient's life, but also cause weakness and dangerous complications. There are two types of headaches caused by changes in pressure inside the skull: headaches caused by decreased intracranial pressure (spontaneous decrease in intracranial pressure, or SIH) and headaches caused by increased intracranial pressure (increased intracranial pressure). idiopathic skull or IIH).

1. Headache caused by pressure changes in the skull

Headache is a common symptom. However, in most cases these attacks are benign (primary headaches). Primary headaches usually occur when the patient is stressed, tired, lack of sleep or consumes a lot of caffeine. Secondary headache, is a headache caused by a physical cause such as a brain tumor, meningitis, changes in intracranial pressure, etc. Secondary headaches can be life-threatening, and need to be treated. promptly diagnosed and treated.
There are two types of headaches caused by changes in pressure inside the skull: headaches caused by decreased intracranial pressure (spontaneous intracranial hypotension, or SIH) and headaches caused by increased intracranial pressure (increased pressure in the skull). idiopathic intracranial or IIH).

2. Headache due to decreased intracranial pressure (SIH)

Headaches caused by decreased intracranial pressure are often worse when the person is standing or sitting and relieved when lying down. Headache caused by decreased intracranial pressure causes pain throughout the head, but usually begins in the back of the head, sometimes causing neck pain. SIH is rare, but it can happen to anyone, at any age.
In addition, accompanying symptoms of pain due to decreased intracranial pressure include:
Hear ringing in your ears. Dizzy. Nausea. Sensitive to sound and light. Tired. The cause of decreased intracranial pressure is a cerebrospinal fluid (CSF) leak, although a CSF leak is usually in your spine, not your skull. CSF is the fluid that surrounds the brain and spinal cord, helping to protect the brain and spinal cord.
To diagnose this disease, after examination, the doctor may order MRI and CT scans of the brain and/or spinal cord to find the cause of the disease. Your doctor may also measure your CSF pressure by placing a needle in your lumbar spine.
Usually, the above symptoms will disappear on their own when the patient has a reasonable rest, drinks a lot of water and limits caffeine.
In addition, some common treatment methods are patching the dural CSF fistula with autologous blood, which helps prevent CSF leakage. Blood is taken from the patient's arm and injected into the leaky area of ​​the spinal canal to repair the fistula. Since the exact location of the CSF leak is difficult to find, this method cannot be performed the first time, but must do more investigations to locate the leak before patching.

3. Headache due to increased intracranial pressure (IIH)

The symptoms of ICP headache are similar to those of brain tumors, hence IIH is often referred to as pseudotumor cerebri: Like a migraine headache, the pain is worse in the morning. Neck and shoulder pain. Headaches that are worse when coughing, sneezing, or working too hard. Severe headaches that last for a long time. Vision changes (blurred vision) or ringing in the ears. IIH is very rare, as in the US, only about 100,000 Americans have it. Most of those affected are obese women of childbearing age.
The cause of IIH disease is stagnation of cerebrospinal fluid leading to increased intracranial pressure. Obesity is one of the main causes of IIH disease, in addition to some drugs such as tetracycline, steroids, growth hormone, even too much vitamin A are also causes.
After taking a close look at the patient's medical history, the doctor will order MRI and CT scans to find the cause of the disease and also to rule out other causes with similar symptoms. Patients are given an eye exam to evaluate visual acuity and visual field because IIH often causes damage to the optic nerve. The disease can lead to papilledema - which greatly affects the patient's vision. This condition can lead to blindness if not treated promptly.
Lumbar puncture is a common method in the treatment of headache caused by increased intracranial pressure, to check the patient's CSF pressure. This is done by inserting a needle into the cerebrospinal fluid space in the lumbar spine and a special instrument called a manometer that measures the pressure of the cerebrospinal fluid. Through this needle, the doctor can also take the cerebrospinal fluid for testing or drain the cerebrospinal fluid,...
The best way to reduce the effects of IIH is to lose weight. Losing weight reduces pressure on the patient's brain and optic nerve. Patients may need bariatric surgery if they are severely obese. Studies show that the symptoms of the disease can be reduced even when the body is reduced by 5%-10% through healthy eating, exercise and cutting salt.
During treatment, patients should also have regular and complete vision tests to monitor complications on the optic nerve of headache due to increased intracranial pressure. In some cases, doctors prescribe acetazolamide to reduce the body's production of CSF. In severe cases, you may need surgery to relieve pressure in the skull. Eye surgery is also a possible treatment option.

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Articles refer to sources: webmd.com, health.harvard.edu