Headaches occur due to various causes, including migraines, tension, sinus infections, dehydration, and eye strain. If a headache doesn’t have a clear cause, it may be idiopathic. For frequent or unusual headaches, medical advice is recommended. Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is a condition marked by increased intracranial pressure without an identifiable cause. This pressure buildup occurs when cerebrospinal fluid accumulates around the brain and spinal cord, leading to headaches, vision issues, nausea, and sometimes memory loss or ringing in the ears. Symptoms resemble those of a brain tumor, and diagnosis involves ruling out other conditions through eye exams, imaging tests, and spinal taps. IIH mainly affects women aged 20-50, especially those who are overweight. Treatment focuses on reducing pressure and symptoms through weight management, medications to lower fluid levels, and, in severe cases, surgical interventions like spinal fluid shunts or optic nerve sheath fenestration. Proper management is essential to prevent vision loss and maintain quality of life. Regular eye exams and maintaining a healthy weight are recommended.
A headache is a pain or discomfort in the head, temples, scalp or neck. Headaches are caused by many different conditions; Let’s take a look at some of the possible causes:
If you have a headache which doesn’t feel like any of the above, you may have an “idiopathic headache”. Idiopathic means the cause is unknown. If you find yourself experiencing headaches often, whatever the cause, please consult a general physician.
Idiopathic intracranial hypertension, also called pseudo tumour cerebri, is a condition that causes headaches, vision problems and nausea. Idiopathic intracranial hypertension is caused by an increase in pressure inside the skull, for no apparent reason. The exact reason for the increased pressure is usually unknown, and so the treatment is typically focussed on relieving the pressure. The symptoms of idiopathic intracranial hypertension are very similar to the symptoms caused by a brain tumour. Patients may experience dizziness, nausea, vomiting, mild memory loss and a persistent ringing sensation in the ears. The high intracranial pressure happens when there is too much cerebrospinal fluid around the brain and the spinal cord. This puts pressure on the brain and the optic nerve, resulting in double vision, loss of peripheral vision, temporary blindness and other vision problems. If you experience any of these symptoms, visit your eye doctor immediately.
Idiopathic intracranial hypertension is rare. It’s most common in women between the ages of 20 to 50. There is no clarity about what causes the condition. However, if the intracranial hypertension has known causes, it is not idiopathic. Intracranial hypertension caused by a stroke or a traumatic accident it is acute intracranial hypertension. If the intracranial hypertension is caused by a blood clot, brain tumour, or long term health problem, it is known as chronic intracranial hypertension.
Idiopathic intracranial hypertension is a pretty rare disease. However, it is noteworthy that overweight women between the ages of 20 and 50 appear to be most susceptible to the condition. It is rare in infants, but can occur in children. Before puberty, both small boys and girls are equally susceptible. This indicates to us that the condition may be influenced by hormonal issues. Patients who are taking certain medications like birth control pills, steroids, accutane (cis-retinoic acid), lithium carbide, growth hormone, amiodarone, or nalidixic acid face a higher risk of developing idiopathic intracranial hypertension. Pre-existing conditions such as Down syndrome, chronic kidney failure, Addisson’s disease, polycystic ovary syndrome, iron deficiency or anaemia, sarcoidosis (inflammation of the lymphatic system system and associated tissues), or systemic lupus erythematosus also increase the patient’s risk of idiopathic intracranial hypertension.
Since the cause of idiopathic intracranial hypertension is unknown, it is diagnosed by the process of elimination. This means that the doctor has to investigate all potential causes of the patient’s headache, and eliminate them all one by one to arrive at this diagnosis.
The diagnosis process usually begins with a patient medical history and a physical exam. The doctor will perform a dilated eye exam and a visual field test, to assess the extent of vision problems. They will also check for swelling of the optic nerve. Imaging test of the brain are then performed to check for structural irregularities like brain tumours, blood clots or aneurysms. This is usually a CT scan or an MRI scan. The doctor will also perform a spinal tap or lumbar puncture. This procedure is done to withdraw a small sample of cerebrospinal fluid from the spine, to check pressure and to test the fluid for abnormalities that could hint at the cause of the headaches.
In patients with idiopathic intracranial hypertension, there is no clear underlying cause that can be identified. So, treatment for it usually focuses on relieving the symptoms by reducing intracranial pressure. The goal is to reduce the severity of the headaches, and prevent any permanent vision loss. There is a correlation between obesity and idiopathic intracranial hypertension, so most patients are advised to lose weight and bring it down into a healthy range. Discuss safe, sustainable ways to lose weight with your doctor. Patients may also be prescribed medication like acetazolamide which helps the body make less cerebrospinal fluid. Some patients are also prescribed diuretics that help your body eliminate excess fluids. If these conservative treatments don’t work, the doctor may recommend surgical intervention.
A spinal fluid shunt is a thin tube or catheter that drains the excess cerebrospinal fluid into another body part where it can be re-absorbed, most commonly the abdominal cavity. Spinal shunts are used to treat emergent cases, where the cerebrospinal fluid build up is extreme and the patient faces a high chance of permanent vision loss. The shunt immediately reduces the intracranial pressure and relieves symptoms. The most common spinal shunts to treat idiopathic intracranial hypertension are the ventriculoperitoneal (VP) shunt and the lumboperitoneal (LP) shunt. The VP shunt drains excess cerebrospinal fluid from the brain, whereas the LP shunt drains excess fluid from the base of the spine.
Optic nerve sheath fenestration is a surgical intervention to manage idiopathic intracranial hypertension. This technique is typically only opted for when conservative management options like weight loss and medication have been ineffective. During this procedure, the surgeon creates an opening in the membrane (nerve sheath) that surrounds the optic nerve. This allows excess built-up cerebrospinal fluid to drain from the optic nerve. Vision stabilises after this procedure and abnormalities in vision resolve. Most patients who have this procedure performed, even in just one eye, notice that vision improves in both eyes. However, the surgery is risky and is only performed when other methods have failed.
Patients with idiopathic intracranial hypertension need to manage the condition well. Untreated, the condition can result in permanent blindness and debilitating symptoms that interfere with the patient’s quality of life. Patients will have to routinely get their vision checked by an ophthalmologist, to avoid damage. Maintaining a healthy weight is also key to keeping the condition under control. If you have a pre-existing condition that increases the severity of your idiopathic intracranial hypertension, you can discuss it with your physician.
If you are struggling with persistent headaches, vision problems, or symptoms of intracranial hypertension, timely medical care is essential. At Kauvery Hospital, our specialists provide advanced diagnostics and personalized treatment to help you manage neurological conditions effectively. With branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy, expert care is always close to you.
Headaches can be caused by migraines, tension, sinus infections, dehydration, or eye strain. In some cases, the cause is unknown (idiopathic headaches).
Seek medical help if your headache is frequent, unusually severe, or comes with symptoms like vision changes, nausea, dizziness, or memory loss.
Yes. If untreated, IIH can lead to permanent vision damage or blindness. Early diagnosis and treatment are essential.
Treatment may include weight loss, medications to reduce fluid buildup, or surgical options such as spinal shunts or optic nerve sheath fenestration in severe cases.
Yes. Maintaining a healthy weight, regular eye exams, and managing underlying health conditions can help control IIH and protect vision.
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