Intracranial hypertension

Treatment for these types of IH depends on the cause.

Tension headache

A tension headache is the most common type of headache. It is pain or discomfort in the head, scalp, or neck, and is often associated with muscle tightness in these areas.

Headaches are usually caused by either muscle tension, vascular problems, or both. Migraines are vascular in origin, and may be preceded by visual disturbances, loss of peripheral vision, and fatigue. Most headaches can be relieved or ameliorated by over-the-counter pain medications.

The most common cause of tension-type headaches is muscle contraction in the head, neck or shoulders.

Causes

• Physical or emotional stress
• Alcohol use
• Caffeine (too much or withdrawal)
• Colds, the flu, or a sinus infection
• Dental problems such as jaw clenching or teeth grinding
• Eye strain
• Excessive smoking
• Fatigue or overexertion

Tension headaches can occur when you also have a migraine. Tension headaches are not associated with brain diseases.

Symptoms

The headache pain may be described as:

• Dull, pressure-like (not throbbing)
• A tight band or vise on or around the head
• All over (not just in one point or one side)
• Worse in the scalp, temples, or back of the neck, and possibly in the shoulders

The pain may occur once, constantly, or daily. Pain may last for 30 minutes to 7 days. It may be triggered by or get worse with stress, fatigue, noise, or glare.

You may have difficulty sleeping. Tension headaches usually do not cause nausea or vomiting.

People with tension headaches often try to relieve pain by massaging their scalp, temples, or the bottom of the neck.

Exams and Tests

If your headache is mild to moderate, without other symptoms, and responds to home treatment within a few hours, you may not need to seek medical attention or have further examination or testing.

With a tension headache, there are usually no problems with the nervous system. But tender points (trigger points) in the muscles are often found in the neck and shoulder areas.

Treatment

The goal is to treat your headache symptoms right away and to prevent headaches by avoiding or changing your triggers. A key step in doing this involves learning to manage your tension headaches at home by:

• Keeping a headache diary to help you identify your headache triggers so that you and your health care provider can make changes in your lifestyle to reduce the number of headaches you get
• Learning what to do to relieve a headache when it starts
• Learning how to take your headache medicines the correct way

Many people can treat their tension headaches with conservative therapy, such as relaxation or stress-management training, including:

• Massage
• Biofeedback
• Cognitive behavioral feedback
• Acupuncture
• Ice or hot packs

When needed, medicines that may relieve a tension headache include:

• Over-the-counter (OTC) pain medicines, such as aspirin, ibuprofen, or acetaminophen
• Narcotic pain relievers are generally not recommended
• Muscle relaxers
• Tricyclic antidepressants or certain anti-seizure medicines to prevent recurrences

• Taking medicines more than 3 days a week may lead to rebound headaches. These are headaches that keep coming back due to overuse of pain medicine.
• Taking too much acetaminophen can damage your liver.
• Too much ibuprofen or aspirin can irritate your stomach or damage your kidneys.

If these medicines do not help, talk to your provider about prescription medicines.

Outlook (Prognosis)

Tension headaches often respond well to treatment. But if the headaches are long-term (chronic), they can interfere with life and work.

When to Contact a Medical Professional

Call 911 or the local emergency number if:

• You are experiencing “the worst headache of your life.”
• You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a headache before.
• The headache starts very suddenly.
• The headache occurs with repeated vomiting.
• You have a high fever or stiff neck with your headache.

Schedule an appointment or contact your provider if:

• Your headache patterns or pain change.
• Treatments that once worked are no longer helpful.
• You have side effects from medicines, including irregular heartbeat, pale or blue skin, extreme sleepiness, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain, cramps, dry mouth, or extreme thirst.
• You are pregnant or could become pregnant. Some medicines should not be taken when pregnant.
• You need to take pain medicines more than 3 days a week.
• Your headaches are more severe when lying down.

Prevention

Learn and practice stress management. Some people find relaxation exercises or meditation helpful. Biofeedback may help you improve the effect of doing relaxation exercises, and may be helpful for long-term (chronic) tension headache.

Tips to prevent tension headaches:

• Keep warm if the headache is associated with cold.
• Use a different pillow or change sleeping positions.
• Practice good posture when reading, working, or doing other activities.
• Exercise the neck and shoulders frequently when working on computers or doing other close work.
• Get plenty of sleep and rest.

Massaging sore muscles may also help.

References

Digre KB. Headaches and other head pain. In: Goldman L, Cooney K, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 367.

Garza I, Robertson CE, Smith JH, Whealy MA. Headache and other craniofacial pain. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff’s Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 102.

Rozental JM. Tension-type headache, chronic tension-type headache, and other chronic headache types. In: Benzon HT, Raja SN, Liu SS, Fishman SM, Cohen SP, eds. Essentials of Pain Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 20.

Version Info

Last reviewed on: 12/31/2023

Reviewed by: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Intracranial hypertension

It can happen suddenly, for example, as the result of a severe head injury, stroke or ruptured brain aneurysm.

It can be caused by a condition that affects your brain, such as a brain abscess, brain tumour, meningitis or encephalitis.

IH can also develop as a complication of another condition such as high blood pressure.

Treatment for these types of IH depends on the cause.

Sometimes though there is no obvious reason why pressure builds up around the brain. Build-up of pressure with no known cause is known as idiopathic intracranial hypertension.

This page is about idiopathic intracranial hypertension.

Symptoms of intracranial hypertension

Symptoms of intracranial hypertension (IH) can include:

• a constant throbbing headache which may be worse in the morning, or when coughing or straining; it may improve when standing up
• temporary loss of vision – your vision may become dark or “greyed out” for a few seconds at a time; this can be triggered by coughing, sneezing or bending down
• feeling and being sick
• feeling sleepy
• feeling irritable
• finding it difficult or painful to look at bright lights (photophobia)
• hearing a pulsing rhythmic noise in your ears (pulsatile tinnitus)
• problems with co-ordination and balance
• mental confusion
• loss of feeling or weakness

Immediate action required: Call 999 or go to A&E if you have any of these symptoms and:

• they’ve come on quickly, such as a sudden severe headache, change in your vision, confusion or weakness
• you’ve recently had a head injury
• you have a high temperature, or you feel generally unwell

Diagnosing intracranial hypertension

A GP may suspect you have intracranial hypertension (IH) if you have symptoms of increased pressure on your brain, such as vision problems and headaches.

If a GP thinks you have IH they’ll refer you to a hospital specialist.

You may have several different tests to diagnose IH, such as:

• an examination to check functions such as your muscle strength, reflexes and balance. Any problems could be a sign of an issue with your brain or nerves
• an assessment of your eyes and vision
• a CT scan or MRI scan of your brain
• a lumbar puncture, where a needle is inserted into your spine to check for high pressure in the fluid that surrounds your brain and spinal cord

Idiopathic IH may be diagnosed if you have increased pressure on your brain and no other cause can be found.

Treatments for idiopathic intracranial hypertension

Treatments for idiopathic intracranial hypertension (IH) can include:

• losing weight if you’re overweight. This can often help to reduce your symptoms and may sometimes relieve them altogether
• stopping any medicine that may be causing your symptoms
• medicine to remove excess fluid from the body (diuretics)
• medicine to reduce the production of cerebrospinal fluid in your brain
• a short course of steroid medicine to relieve headaches and reduce the risk of vision loss

Surgery

Surgery may be considered if other treatments do not help, particularly if your vision is getting worse or you’re at risk of loss of vision.

The main types of surgery for idiopathic IH are:

• shunt surgery – a thin, flexible tube is inserted into the fluid-filled space in your skull or spine to divert excess fluid to another part of your body
• optic nerve sheath fenestration – the protective layer surrounding your optic nerve (the nerve connecting the eye to the brain) is opened up to relieve pressure on it and allow fluid to drain away

These procedures can provide relief from your symptoms, but they also carry a risk of potentially serious complications. Talk to the surgeon about what your operation involves and what the risks are.

Risk factors for idiopathic intracranial hypertension

While the cause, or causes, of idiopathic IH is unknown, a number of risk factors have been linked to the condition.

It’s a rare condition that mainly affects women in their 20s and 30s. It most often happens in women who have gained weight. The reason for this is unclear.

Other factors that have been linked with idiopathic IH include:

• some hormone conditions such as hypoparathyroidism or Addison’s disease
• taking certain medicines including some antibiotics, lithium (for mental health problems) and medicines for thyroid problems
• high levels of vitamin A
• a lack of red blood cells (iron deficiency anaemia)
• lupus – a problem with the immune system

Complications of idiopathic intracranial hypertension

Idiopathic IH is not usually life threatening, but it can be a lifelong problem.

It can affect your vision, and there’s a risk that you could lose your vision. This is because the increased pressure around the brain can cause swelling of the optic nerve.

Treatment can help with problems with your vision and can reduce the risk of loss of vision.

It’s important to tell your doctor straight away if you notice any changes in your vision.

Page last reviewed: 28 March 2023
Next review due: 28 March 2026