Low-Pressure and High-Pressure Headaches

Almost everybody gets a headache once in a while. For some, though, headaches are an inconvenient -- sometimes debilitating -- part of their lives.

If you get regular headaches, it’s important to work with your doctor to uncover the cause and find out how to treat it. That’s not always easy because headaches can be caused by many things, from eating ice cream too quickly, to stroke, to many other serious 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, or SIH) and high-pressure headaches (idiopathic intracranial hypertension, or IIH).

Low-Pressure Headaches (SIH)

A low-pressure headache often gets worse when you stand or sit. It can get better if you lie down. It can start at the back of the head, sometimes with neck pain, though it can be felt all over your head. It often gets worse with coughing, sneezing, and exertion. It can come with:

You might feel a stabbing pain, throbbing, or just overall pressure in your head. SIH is rare and can affect anyone of any age.

Causes: SIH happens because of a leak of cerebrospinal fluid (CSF), although the leak is usually in your spine, not your skull. CSF is the “cushioning” fluid that protects your brain and your spine.

Diagnosis: After an exam, your doctor may do MRI and CT scans to figure out what's going on. They may also measure your CSF pressure by putting a needle in your back near your spine. Some experts say that might not help low-pressure headaches that much.

Treatment: Your symptoms may go away by themselves. Sometimes, rest, drinking lots of water, and caffeine may help.

A common treatment is 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 -- the actual spot where the CSF leaks is hard to find -- so you may have to go through the procedure several times. Your doctor may prescribe a medicine called theophylline.

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High-Pressure Headaches (IIH)

The symptoms of a high-pressure headache often mimic those of a brain tumor, which is why IIH used to be 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
  • Headaches that get worse with coughing, sneezing, or exertion
  • Severe headaches that last for a long time
  • Changes in vision or a ringing in the ears

IIH is rare. Only about 100,000 Americans have it. Most of them are obese women of childbearing age.

Causes: IIH is caused by higher pressure in the skull from too much CSF. Obesity is the main reason, though some medications -- including tetracycline, steroids, growth hormone, even too much vitamin A -- can cause it.

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. IIH almost always puts pressure on the optic nerve. This leads to swelling called papilledema. That swelling can greatly affect your vision. It can lead to blindness if it's not caught in time.

Your doctor will give you a spinal tap (they may call it lumbar puncture) to test your CSF pressure. A needle is inserted between two vertebrae in your lower back, and a special tube called a manometer measures the pressure.

Treatment: 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. Studies show that even modest weight loss of 5%-10% -- done through healthy eating, exercise, and cutting back on salt -- can ease symptoms.

During treatment, regular and complete vision testing should be done, too, to keep an eye on pressure on your optic nerve. In some cases, a medication called acetazolamide is used to cut back on 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.

WebMD Medical Reference Reviewed by Nayana Ambardekar, MD on April 11, 2018

Sources

SOURCES:

The Migraine Trust: “Headache.”

Mayo Clinic: “Headache.”

American Migraine Foundation: “What to Know About Low-Pressure Headaches.”

National Organization for Rare Disorders: “Spontaneous Intracranial Hypotension.”

Current Neurology and Neuroscience Reports: "Spontaneous intracranial hypotension."

Spinal CSF Leak Foundation.

National Eye Institute: “Idiopathic Intracranial Hypertension.”

American Migraine Foundation: “The Low Down on High-Pressure Headache.”

Neurosurgery: "Trigeminal Neuralgia in a Patient with a Dural Arteriovenous Fistula in Meckel's Cave: Case Report."

Current Treatment Options in Neurology: " Idiopathic Intracranial Hypertension (Pseudotumor Cerebri): Recognition, Treatment, and Ongoing Management."

Johns Hopkins Medicine: "Lumbar Puncture."

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