Extremes of intracranial pressure commonly cause
headache.
Benign intracranial hypertension is a rare syndrome of increased intracranial pressure manifesting as
headache, intracranial noises, transient visual obscuration, and
palsy of the sixth cranial nerve. Endocrine disorders such as
obesity and
hypoparathyroidism,
hypervitaminosis A,
tetracycline use and thyroid replacement are probable causes of
benign intracranial hypertension. In the majority of cases, however, it is idiopathic.
Benign intracranial hypertension is though to be caused by
cerebral edema, high cerebrospinal fluid outflow resistance and high cerebral venous pressure, or a combination of the three. The management of
benign intracranial hypertension includes, symptomatic
headache relief, removal of offending risk factor(s), and medical or surgical reduction of intracranial pressure.
Spontaneous intracranial hypotension is more rare than
benign intracranial hypertension. Postural
headache (worse in the upright position) is the hallmark of
spontaneous intracranial hypotension. Typically, the cerebrospinal fluid pressure is less than 60 mm H2O. Diminished cerebrospinal fluid production, hyperabsorption, and leak are postulated mechanisms of
spontaneous intracranial hypotension. Empirical treatment includes
bed rest, administration of
caffeine,
corticosteroids or
mineralocorticoids,
epidural blood patch, and epidural saline infusion.