Headaches caused by increased ICP

Causes- Tumours, hydrocephalus, benign intracranial hypertension, subdural haematoma, secondary to inflammatory process (e.g. meningitis).

Symptoms/Signs- headache worse in early morning, worse on coughing/bending, persistent vomiting, focal neurological signs, papilloedema, horizontal diplopia.

Investigations:

– MRI is preferred to CT so as to avoid radiation exposure. Small ventricles may be the only finding. MRV may be necessary to exclude thrombus. Optic Nerve sheath ultrasound measurement can also be used in the ED [1]. LP should be reserved until after imaging given the risk of coning, with opening and closing pressures being measured.

Treatment- Aims to reduce the long-term sequale of visual loss.
Acetazolamide 25mg/kg/day
Topiramate
Repeat LP
Treat underlying cause

The CTs above show the effects of benign ICP with the cortex compressed against the skull, with loss of distinction between the sulci and gyri.