Intracranial hypertension (IH) is a condition in which pressure builds in the fluid around the brain.

Here’s what you should know about IH, the symptoms, and what treatments may help.

Your brain is surrounded by a liquid called cerebrospinal fluid (CSF).

When the pressure of this fluid gets too high in the space around your brain, it causes intracranial (“inside the skull”) hypertension (“high pressure”).

IH can occur as the result of a head injury, a stroke, a tumor, hydrocephalus, or an infection. When the cause is known, it’s called acute or secondary IH. When it has no known cause, it’s referred to as idiopathic IH. Anyone can develop idiopathic IH.

When the pressure around the brain gets too high, it causes a variety of symptoms, such as headaches and vision problems. If left untreated, acute IH may lead to death. Idiopathic IH can lead to blindness as a result of pressure on the optic nerve.

Pseudotumor cerebri

Idiopathic IH was previously known by the name “pseudotumor cerebri,” which means “false brain tumor.” This terminology is now outdated.

However, some medical professionals still use this term, and it does help describe some of the issues idiopathic IH may lead to and how they mimic the symptoms that brain tumors can cause.

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You will likely receive an IH diagnosis if your intracranial pressure is higher than 250 mm H2O. Pressure readings of 200 to 250 mm H2O fall into a borderline high category. “Normal” pressure readings vary by age. In adults, they are generally between 70 and 180 mm H2O.

Acute IH is associated with various medical issues and infections that can lead to buildup of blood or other fluids around the brain. If you have any of these conditions or a head injury, your doctor will likely look out for IH.

Idiopathic IH is more common in women ages 20 to 45 who are overweight. It’s a rare condition that affects only some 7.8 in 100,000 people, based on 2017 data. The incidence has increased quite a bit, from 2.3 in 100,00 people in 2003 and just 1 in 100,000 in the 1990s.

Idiopathic IH is more common in women than in men or children. When researchers examined 1,765 cases specifically, 85% of the people with idiopathic IH were women.

If you have IH, you may feel like you have a throbbing headache all the time. This headache may feel particularly bad in the morning or when you’re bending over, coughing, or straining in some way. It may even wake you up from a deep sleep.

Along with the pressure in your head, you may experience:

The pressure may also cause your optic nerve to swell. As a result, your vision may fade, seeming dark or “grayed out” in one or both eyes. You may notice more visual issues when you bend over, strain, cough, or sneeze.

Acute IH can be treated by addressing the underlying cause of the pressure buildup.

There are a number of ways to treat idiopathic IH, ranging from more conservative to more invasive options. Your doctor will take into account your health history and any contributing factors before prescribing a treatment plan.

Possible treatments include:

  • Pursuit of weight loss: Losing weight may help relieve or lessen symptoms.
  • Medication cessation: Stopping medications that may contribute to idiopathic IH, such as birth control pills, may relieve symptoms as well.
  • Diuretics: These medications can help your body shed fluids and may lower the pressure in your head.
  • CSF reduction medications: Acetazolamide and other carbonic anhydrase inhibitors are medications that may reduce your body’s production of CSF.
  • Steroids: These drugs may help reduce headaches and lower the risk of permanent vision loss.
  • Lumbar puncture: Your doctor may suggest going to the hospital to receive regular lumbar punctures, also called spinal taps. This procedure involves inserting a hollow needle into a space in your spine and removing fluid, which can relieve pressure from the excess CSF.

If these treatments do not work, your doctor may recommend the following surgerical procedures:

  • Neurological shunt placement: This procedure involves placing a tube in the affected area to drain extra CSF to another part of your body and relieve pressure.
  • Optic nerve fenestration: This procedure involves making a cut into the membrane surrounding the optic nerve. This can reduce the pressure and save your vision.

Acute IH may respond to treatment of the underlying condition, such as a brain tumor or hydrocephalus. Without treatment, though, the pressure may build and can lead to death.

Idiopathic IH does not typically lead to death, but it may be a lifelong condition.

With adequate treatment, most people with idiopathic IH can get better to varying degrees. The key is to determine any underlying factors, such as obesity or medication use, that might be contributing to the pressure buildup.

While you may get better for some time after treatment, symptoms may return and require additional treatment or a different treatment approach. Vision loss is of particular concern. An estimated 1 out of every 5 to 20 people with idiopathic IH may experience permanent vision loss.

Can you drive with intracranial hypertension?

You may or may not be able to drive with IH. It depends on the severity of your symptoms. If your IH has affected your vision, you should not drive. In the Facebook group Life with Idiopathic Intracranial Hypertension, members share issues that have led people to stop driving. These include visual impairment, seizures, and surrendering a driver’s license after getting shunts.

When should you go to the ER with intracranial hypertension?

You should visit the emergency room (ER) with IH if your headache becomes severe. There are treatments available that may help, such as a lumbar puncture. You should also go to the ER if you have worsening vision issues. Without treatment, idiopathic IH can lead to permanent vision loss.

Is there a link between COVID-19 vaccines and intracranial hypertension?

A recent case report suggests that there may be a link between COVID-19 vaccines and increased intracranial pressure. However, it’s important to note that this report describes just one person who did not have other risk factors for idiopathic IH. More research is needed to determine whether there is a clear connection. Another recent case report shows a similar result. Additionally, a 2020 case report suggests that COVID-19 infection, rather than the vaccine, may be associated with IH. However, both of these reports also describe cases involving only one person, and further research is needed.

Is benign intracranial hypertension a disability?

If you have received a diagnosis of idiopathic IH, you may be eligible for disability. More information, including an application for disability insurance, is available on the Social Security Administration website.

What is the ICD-10 code for idiopathic intracranial hypertension?

The ICD-10 code for idiopathic intracranial hypertension is G93.2. It is classified as a disease of the nervous system.

Let your doctor know if you experience symptoms such as headache, nausea or vomiting, and visual problems. If an injury or illness is causing your IH, treatment of the underlying issue may help.

While idiopathic IH is a rare condition that primarily affects women with obesity, it can affect people of any sex or age. Doctors cannot always determine the exact cause of IH, but there are a variety of treatments that may relieve pressure to help you feel better.