Intracranial Hypertension Headache, although not commonly seen in the community, is an important neurological syndrome that can lead to serious consequences when diagnosis is delayed. Headache is generally associated with stress, fatigue, or simple infections; however, sometimes it can be the first sign of vital conditions such as increased intracranial pressure.

Headache diseases are examined in a wide range from tension-type pains to migraine, from cluster headache to sinusitis-originated pains. Intracranial Hypertension within this range acts like a “pseudotumor cerebri,” raising intracranial pressure and especially creating pressure on the optic nerve, potentially causing permanent vision loss.

In this article, I address the causes, symptoms, diagnostic methods, and treatment options of Intracranial Hypertension Headache both with scientific accuracy and in an understandable manner.

What is Intracranial Hypertension Headache?

Intracranial Hypertension Headache is a condition that occurs when pressure inside the skull (intracranial) abnormally increases without tumor, infection (e.g., meningitis), hydrocephalus, or vascular occlusion. This increase occurs as a result of elevated cerebrospinal fluid (CSF) pressure and is also defined as increased intracranial pressure syndrome.

Under normal conditions, CSF is continuously produced in chambers called ventricles inside the brain. It then circulates around the brain and spinal cord, and after completing its task, is reabsorbed by cerebral veins (venous system). This production-absorption cycle is a delicate balance mechanism that ensures intracranial pressure remains constant.

In Intracranial Hypertension, this balance is disrupted:

• CSF production may increase,
• CSF reabsorption may slow down,
• A blockage may occur in intracranial venous return.

As a result, fluid volume increases in the skull, which is a closed system, and pressure rises. This increased pressure creates pressure on brain tissue and especially the optic nerve, causing headache and vision disorders.

This picture, because it closely resembles the pressure increase caused by a brain tumor, is also called “Pseudotumor Cerebri” or “False Brain Tumor” in medical literature.

What Causes Intracranial Hypertension Headache?

Intracranial hypertension headache occurs with various factors that cause increased intracranial pressure. It has two main forms: idiopathic (unknown cause) and secondary.

Intracranial Hypertension Headache is examined in two groups according to why intracranial pressure increases:
1. Idiopathic (unknown cause)
2. Secondary (related to another disease)

This distinction is of great importance both for the diagnostic process and treatment plan.

1. Idiopathic Intracranial Hypertension (IIH)

The idiopathic form constitutes most of all cases. The term “idiopathic” describes situations where no specific structural or systemic cause can be identified.
However, some risk factors are strongly associated with the disease:

• Obesity:
  It is the most important risk factor. The frequency of occurrence increases markedly especially in women of childbearing age (20-45 years).
  It is thought that adipose tissue affects hormonal balances and cerebrospinal fluid (CSF) absorption, thereby increasing intracranial pressure.
  Therefore, Intracranial Hypertension is often also referred to as “false brain tumor” seen in obese women.
• Gender and Age:
  It is seen approximately 9 times more frequently in women than in men. It is most commonly encountered in young and middle-age groups.
• Weight Gain:
  Rapid and marked weight gain can trigger the disease. Weight control is therefore a fundamental part of treatment.

2. Secondary Intracranial Hypertension

In the secondary form, there is a clear underlying condition causing the increase in intracranial pressure.
These causes can vary and some require urgent intervention:

• Medication Use:
  Some medications can increase CSF pressure.
  Especially tetracycline group antibiotics (used in acne treatment), vitamin A derivatives (retinoids), growth hormones, and sudden cessation of cortisone can create risk.
• Systemic Diseases:
  Systemic Lupus Erythematosus (SLE), Behçet’s disease, kidney failure, some blood diseases, or endocrine disorders can lead to secondary pressure increase.
• Cerebral Venous Sinus Thrombosis:
  Blockage of the vessels where CSF is reabsorbed with a clot prevents fluid drainage and causes rapid increase in intracranial pressure.
  This situation is a serious picture requiring urgent neurological intervention.

These factors play a direct role in the development of Intracranial Hypertension Headache.
Early detection is critically important for preventing permanent vision loss and chronic headache.

What Are the Symptoms of Intracranial Hypertension Headache?

Increased intracranial pressure can manifest itself with various and sometimes misleading symptoms. Symptoms generally develop gradually and their severity increases over time.

• Headache: It is the most basic symptom seen in more than 90% of patients. This pain generally has the following characteristics:
  • It is often daily and chronic.
  • It is typically throbbing in character.
  • It is generally worse in the mornings or after lying down for a long time.
  • It is intensified by movements that increase intracranial pressure such as coughing, sneezing, or straining.
  • It can be felt throughout the head or in the neck region.
• Vision Disorders: This is the most dangerous and urgent aspect of the syndrome. High pressure presses on the optic nerve (optic nerve) that carries images from the eye to the brain and causes edema (papilledema) there. If left untreated, this condition can lead to permanent vision loss and blindness. Visual symptoms include:
  • Temporary Vision Losses: Momentary darkening or blurring lasting seconds, generally occurring when bending and standing up.
  • Blurred Vision: Decrease in visual acuity.
  • Peripheral Visual Field Loss: Narrowing of side vision, also known as “tunnel vision.”
  • Double Vision (Diplopia): Double vision especially occurring in lateral gaze.
• Pulse-Synchronized Tinnitus (Pulsatile Tinnitus): It is a very typical symptom seen in more than half of patients. The person hears a buzzing, wind sound, or “shh” sound in their ear synchronized with heartbeats. This sound is generally more prominent in quiet environments.
• Other Symptoms: Less specific symptoms such as neck, shoulder, and back pain, dizziness (vertigo), nausea, and vomiting can also accompany the picture.

Intracranial hypertension headache occurs with increased intracranial pressure. The most common symptoms are headache, vision disorder, pulsatile tinnitus, and nausea.

Intracranial Hypertension Headache manifests itself with various symptoms due to the effect of increased intracranial pressure. These symptoms generally start slowly, intensify over time, and seriously affect the patient’s daily life.

The most commonly seen findings are:

1. Headache

More than 90% of patients have headache, and this is the most prominent finding of the disease.
Intracranial hypertension headache has the following characteristics:

• Generally daily, continuous, and throbbing
• Intensifies in the mornings or after lying down for a long time.
• Worsens with movements that increase intracranial pressure such as coughing, sneezing, straining.
• Pain is felt throughout the head or in the neck region.

These features help distinguish it from simple migraine or tension-type headaches.

2. Vision Disorders

Vision problems are the most serious and urgent aspect of this disease.
Rising intracranial pressure creates papilledema (edema) at the head of the optic nerve. If left untreated, permanent vision loss can develop.

Visual symptoms include:

• Temporary vision blackouts: Seconds-long blurring, especially when bending and standing up.
• Blurred vision: Decrease in visual acuity.
• Visual field loss: Narrowing of side vision described as “tunnel vision.”
• Double vision (diplopia): Especially seen in lateral gaze, due to 6th nerve compression.

These symptoms show that Intracranial Hypertension Headache affects the optic nerve and require urgent neurological evaluation.

3. Pulse-Synchronized Tinnitus (Pulsatile Tinnitus)

Seen in more than half of patients.
The person feels a buzzing, “ringing,” or “shh” sound in their ear synchronized with heartbeat.
This symptom is related to fluctuations in intracranial pressure and is generally more prominent in quiet environments.

Pulsatile tinnitus is an important clue specific to Intracranial Hypertension Headache.

4. Other Symptoms

Because increased intracranial pressure affects brain membranes and nerves, other symptoms can also be seen:

• Neck, shoulder, and back pain
• Dizziness (vertigo)
• Nausea and vomiting
• Difficulty concentrating or clouded consciousness

These symptoms generally progress together with headache and vision problems.

International Classification of Headache Disorders (ICHD-3) Diagnostic Criteria – 7.1 Headache attributed to increased cerebrospinal fluid (CSF) pressure

Intracranial Hypertension is defined in ICHD-3 classification as “Headache Due to Increased Intracranial Pressure (7.1.1).”
These criteria are accepted as the diagnostic standard worldwide:

1. Headache related to increased intracranial pressure.
   B. At least one of symptoms such as vision disorders (e.g., temporary vision blackouts, papilledema) or pulse sound in the ear (pulsatile tinnitus) must be present.
   C. Brain imaging must not show mass, hydrocephalus, or other structural lesion.
   D. CSF opening pressure measured during lumbar puncture must be ≥25 cmH₂O (≥28 cmH₂O in obese patients).
   E. Headache must significantly decrease or disappear when intracranial pressure returns to normal.

These criteria are used in Intracranial Hypertension Headache diagnosis both clinically and at research level.

How is Intracranial Hypertension Headache Diagnosed?

Intracranial Hypertension Headache diagnosis is made by careful evaluation of clinical findings and support by imaging. The goal is to exclude other diseases that could cause increased intracranial pressure and determine the degree of pressure increase.

1. Clinical Evaluation

The first step in diagnosis is detailed patient history and neurological examination.

• Headache increasing in the mornings or with coughing, sneezing,
• Blurred vision, temporary blackouts, double vision,
• Hearing a sound synchronized with heartbeat in the ear (pulsatile tinnitus)
  complaints are guiding for diagnosis.

The most important finding in examination is papilledema. Seeing edema at the optic nerve head in fundoscopic examination suggests increased intracranial pressure.

2. Imaging Methods

Brain magnetic resonance imaging (MRI) is performed to support diagnosis and exclude other causes such as tumor, vascular occlusion, hydrocephalus.
The following findings on MRI favor Intracranial Hypertension:

• Reduction in brain ventricles
• Compression or flattening of pituitary gland
• Enlargement in optic nerve sheath
• Narrowing in transverse sinuses (detected with MR venography)
• Contrast enhancement in dura mater

These findings indirectly show increased intracranial pressure.

3. Lumbar Puncture (Spinal Tap)

Lumbar puncture is performed to confirm diagnosis.
This procedure measures the opening pressure of cerebrospinal fluid (CSF).
Pressure, which is normally 10-20 cmH₂O, is generally above 25 cmH₂O in patients with Intracranial Hypertension Headache.
The content of the obtained fluid is generally normal; this is a typical finding supporting diagnosis.

Temporary reduction of the patient’s headache when pressure is lowered also strengthens diagnosis.

4. Other Diagnostic Methods

In some patients, additional tests may be applied to support the diagnostic process:

• Visual field test: Determines the degree of vision loss.
• OCT (Optical Coherence Tomography): Enables objective evaluation of papilledema.
• Venous sinus MR venography: Shows venous occlusions or stenoses.

5. Importance of Early Diagnosis

Early diagnosis is critically important in preventing permanent vision loss.
The shorter the pressure on the optic nerve, the higher the probability of recovery.
Therefore, people experiencing persistent headaches, especially worsening in the mornings, or blurred vision should consult a neurology specialist without delay.

Intracranial Hypertension Headache Treatment

In intracranial hypertension headache treatment, medications such as weight loss, acetazolamide and topiramate, and shunt surgery if necessary are applied. Vision loss can be prevented with treatment.

Intracranial Hypertension Headache treatment aims to alleviate headache, lower cerebrospinal fluid (CSF) pressure, and most importantly prevent vision loss.
The treatment plan is prepared personally for each patient according to the severity of symptoms, vision status, and disease progression rate.

1. Lifestyle Changes and Weight Loss

In the idiopathic (unknown cause) form, especially weight loss in obese patients forms the basis of treatment.
Research shows that losing only 5-10% of body weight significantly reduces intracranial pressure.

Therefore:

• A personalized nutrition plan with a dietitian,
• Regular exercise (low-impact sports such as walking, yoga, swimming)
  are of great importance for permanent success of treatment.

In patients where weight control is achieved, both headache frequency decreases and risk of vision loss significantly drops.

2. Medication Treatment

In intracranial hypertension headache treatment, medications are used to reduce CSF production and lower intracranial pressure.

• Acetazolamide:
  This is the first choice medication in treatment of this condition.
  As a diuretic, it reduces CSF production and balances intracranial pressure.
  Dose is adjusted according to patient’s tolerance and side effects.
• Topiramate:
  It is an antiepileptic effective both as pressure reducer and on migraine-like headache.
  It is also preferred in obese patients because it helps with weight loss.

In some cases, additional diuretics such as furosemide may also be used short-term.
Regular eye examinations during medication treatment are important.

3. Interventional and Surgical Treatments

Interventional methods are applied in patients who do not respond to medication treatment, whose vision loss is progressing rapidly, or whose headache cannot be controlled.

1. Repeated Lumbar Punctures

Intracranial pressure is temporarily lowered by removing CSF from the lumbar region.
This method generally provides short-term relief.

2. Optic Nerve Sheath Fenestration

Preferred in patients with rapidly progressing vision loss.
The membrane surrounding the optic nerve is surgically opened, reducing pressure on the nerve.
It is an effective method in preserving visual function.

3. Shunt Surgeries (Lumboperitoneal or Ventriculoperitoneal Shunt)

One of the most common and permanent treatment methods.
Cerebrospinal fluid is directed from the brain to the abdominal cavity through a thin tube.
This way, excess fluid is drained and intracranial pressure is kept under control.

Regular check-ups are needed after shunt surgery because complications such as shunt blockage or infection can rarely occur.

Treatment Follow-up and Quality of Life

Patients should be checked at regular intervals after treatment:

• Resolution of papilledema is monitored with fundoscopic examination.
• Possible losses are detected early with visual field tests.
• Weight monitoring and lifestyle maintenance are effective in preventing relapses.

With appropriate treatment, in the vast majority of patients, both headache is controlled and vision is preserved. In conclusion, Intracranial Hypertension Headache is a serious neurological condition that should be considered especially in overweight young women with persistent headache and vision complaints. The fact that it is called “false brain tumor” does not mean it is harmless; on the contrary, if left untreated, it can lead to devastating consequences such as permanent blindness. Therefore, it is vitally important for people with the described symptoms to consult a neurology and ophthalmology specialist without delay.

Frequently Asked Questions About Intracranial Hypertension Headache

1. Is Intracranial Hypertension related to weight? Will it completely improve if I lose weight?

Yes. The strongest and proven risk factor for Idiopathic Intracranial Hypertension is obesity.
Excess weight causes increased intracranial pressure by disrupting cerebrospinal fluid (CSF) circulation and hormonal balance.

Weight loss is the cornerstone of treatment.
Only 5-10% reduction in body weight normalizes intracranial pressure in many patients, greatly corrects headache and vision problems.
Regular weight control is the most effective method in preventing disease recurrence.

2. Why is it called “False Brain Tumor” (Pseudotumor Cerebri)? Is there really a tumor?

No. Intracranial Hypertension Headache is called by this name because it causes symptoms as if there is a tumor even though there is no tumor in your brain.
Severe headache, nausea, vomiting, and optic nerve swelling (papilledema) mimic brain tumors.

However, no tumor is detected on brain MRI or CT imaging.
Therefore, the condition is described as “Pseudotumor Cerebri” or “false brain tumor”.

3. What is the most dangerous symptom of this disease? When should I urgently go to the doctor?

The most dangerous symptom is vision loss.
Increased intracranial pressure presses on the optic nerve, leading to papilledema.
If left untreated, this condition can result in permanent vision loss or blindness.

If any of the following symptoms exist, urgent consultation with neurology and eye doctor is necessary:

• Sudden vision blackout when bending and standing up
• Blurring or tunnel vision
• Double vision (especially in lateral gaze)
• “Ringing” sound synchronized with pulse in the ear

4. What is the test that confirms diagnosis?

The gold standard test that confirms diagnosis is lumbar puncture (spinal tap) procedure.
Before this procedure, brain MRI imaging is performed; tumor or structural causes are excluded.

During lumbar puncture, the pressure of cerebrospinal fluid is measured.
The value, which is normally 10-20 cmH₂O, is generally above 25 cmH₂O in Intracranial Hypertension Headache.
Additionally, the obtained fluid helps exclude other causes such as infection or inflammation in laboratory analysis.

5. Does this disease completely pass with medication treatment and weight loss? Does it recur?

In most patients, yes, complete recovery is possible with treatment. Medication treatment (e.g., acetazolamide or topiramate) and weight loss normalize intracranial pressure. This period is called “remission,” meaning the disease’s dormant period.

However, the disease can recur. Especially regaining weight can cause Intracranial Hypertension Headache to relapse. Therefore, maintaining ideal weight and regular neurological and eye check-ups are very important.