There are many causes of headaches, from stress to diet to serious medical conditions. Two types of headaches are caused by a change of pressure inside your skull: low-pressure headaches (your doctor may call them spontaneous intracranial hypotension) and high-pressure headaches (idiopathic intracranial hypertension). These headaches are caused by changes in the levels of cerebrospinal fluid, which surrounds and cushions your brain.
Low-Pressure Headaches
A low-pressure headache, or spontaneous intracranial hypotension (SIH), happens because of a leak of cerebrospinal fluid (CSF), although the leak is usually in your spine, not your skull.
Low-pressure headache symptoms
Symptoms usually start at the back of your head, sometimes with neck pain. The pain can be stabbing, throbbing, or just overall pressure in your head. It often gets worse with coughing, sneezing, and exertion, as well as when you stand or sit. It can get better if you lie down.
Other symptoms of low-pressure headaches are:
Low-pressure headache diagnosis
During your exam, your doctor may do a Trendelenburg test, where you lie flat and your head is tilted lower than the rest of your body, to see if your headache worsens. They may also do MRI and CT scans to figure out if something else could be causing your headaches.
Treatment. The usual medicines used to treat headaches are typically not effective for low-pressure headaches. Treatment normally involves lying flat, drinking fluids, and having caffeine -- either in beverage or pill form.
If this doesn't work, you may need something called an epidural blood patch, which tries to stop your CSF leak. Blood is taken from your arm and injected into an area of your spinal canal to “patch” the leak. This may not work the first time, as the actual spot where the CSF leaks is hard to find. So, you may have to go through the procedure several times.
High-Pressure Headaches
A high-pressure headache, or idiopathic intracranial hypertension (IIH), is caused by high pressure in the skull from too much CSF. This increases pressure on your brain and the optic nerve in the back of your eye.
Obesity is the main cause. Some medications, including tetracycline, steroids, growth hormone, and even too much vitamin A, can also cause it.
High-pressure headache symptoms
The symptoms of a high-pressure headache often mimic those of a brain tumor, which is why IIH is also called “pseudotumor cerebri” or “false brain tumor.” Those symptoms include:
- Migraine-like or throbbing pain that's often worse in the morning
- Neck and shoulder pain
- Severe headaches that last a long time
- Changes in vision
- Ringing in the ears
High-pressure headache diagnosis
After going over your medical history, your doctor will probably ask for MRI and CT scans to help figure things out. You may have several different kinds of vision tests, too.
Your doctor will order MRI and CT scans to check for other causes, such as an intracranial lesion. They'll also do a spinal tap, in which your doctor inserts a needle between two vertebrae in your lower back to measure CSF pressure.
High-pressure headache treatment
The goal of treatment is to reduce the pressure because high pressure can permanently damage your vision. The best way to ease the effects of IIH is to lose weight. That lowers the pressure on your brain and your optic nerve. You may need weight loss surgery if you're severely obese.
In some cases, a medication called acetazolamide is used to reduce your body's production of CSF. In severe cases, you may need surgery to ease the pressure on your brain. Eye surgery is another possibility.
Takeaways
Low-pressure and high-pressure headaches are caused by a change in the amount of cerebrospinal fluid that cushions your brain. These headaches can be quite painful and possibly damage your vision, so it's important to work with your doctor to find the best treatment plan. This might involve taking medication, losing weight, or having a medical procedure.
