High Pressure Headache Idiopathic Intracranial Hypertension (IIH) Pseudotumor

Friedman DI. Headaches Due to Low and High Intracranial Pressure. Continuum (Minneap Minn). 2018 Aug;24(4, Headache):1066-1091.

Headache Clinical Features in IIH

  • Throbbing or pulsatile
  • Headache worsens on awakening
  • May be lateralized
  • Intermittent or persistent, occur daily or less frequently
  • Associated nausea and vomiting are not infrequent
  • Headache exacerbation with changes in posture
  • Relief occurs with nonsteroidal antiinflammatory medications and/or rest
  • Retrobulbar pain and mild pain with eye movement or globe compression
  • In some patients, the pain follows a trigeminal or cervical nerve root distribution
  • Neck stiffness and back pain are also commonly reported

IIH Clinical Features

  • Papilledema
  • Headache (84 to 92%)
  • Transient visual obscurations (68 to 72%)
  • Intracranial noises (pulsatile tinnitus; 52 to 60%)
  • Photopsia (48 to 54%)
  • Back pain (53%)
  • Retrobulbar pain (44%)
  • Diplopia (18 to 38%), typically from nonlocalizing sixth nerve palsy
  • Sustained visual loss (26 to 32%)
  • Neck pain (41%)