What Does a Pseudotumor Cerebri Headache Feel Like?

Pseudotumor cerebri occurs when intracranial pressure (pressure within the skull) increases. The cause is usually unknown. Hence, it's also called idiopathic (unknown cause) intracranial hypertension. The condition is characterized by headaches, which is also the first symptom of pseudotumor cerebri.

Pseudotumor cerebri headaches usually feel like a headache that occurs at the back of the head or behind the eyes. The pain starts as a dull, aching pain that worsens at night or in the morning. They may be associated with vomiting as well. Patients may also eventually develop visual problems and blindness due to inflammation of the optic nerve (the nerve that travels from the back of the eye to the brain), which occurs as a result of increased intracranial hypertension. Other common types of headaches such as migraine or tension headaches may coexist with pseudotumor cerebri, which can result in the condition being misdiagnosed. The symptoms of pseudotumor cerebri are similar to those of a brain tumor. Pseudotumor cerebri can occur at any age, but it's most common in obese women who are of childbearing age. Treatment of pseudotumor cerebri involves medications, lifestyle medications and even surgery in some cases.

The exact cause of pseudotumor cerebri is unknown. The brain and spinal cord are surrounded by the cerebrospinal fluid, which acts as a cushion, protecting the brain and skull from injury. The cerebrospinal fluid is produced by the brain and gets absorbed into the bloodstream at a rate that maintains the pressure in the brain. Sometimes, the rate of production of the cerebrospinal fluid is higher than that of absorption due to problems in the absorption process. This causes accumulation of cerebrospinal fluid that increases the intracranial pressure, resulting in pseudotumor cerebri.

Risk factors for pseudotumor cerebri: The following factors may increase the risk of pseudotumor cerebri

• Obesity: Women who are obese and of childbearing age are at higher risk.
• Medications: Substances that may increase intracranial pressure include
  • Growth hormone
  • Tetracycline
  • Excess vitamin A
• Medical conditions: Certain conditions and diseases increase the risk of pseudotumor cerebri and intracranial hypertension including 
  • Lupus
  • Anemia
  • Blood-clotting disorders
  • Addison’s disease
  • Kidney disease
  • Polycystic ovary syndrome (PCOS)
  • Sleep apnea

Symptoms that may resolve with treatment can recur months or years later. Some common signs and symptoms of pseudotumor cerebri might include

• Frequent episodes of severe headaches that may originate from the back of the head or behind the eyes
• A whooshing sound in your head or inside the ears that correlates with the heartbeat
• Nausea and vomiting
• Giddiness 
• Difficulty in peripheral vision 
• Double vision
• Blurring of vision 
• Seeing light flashes
• Episodes of blindness in one or both eyes and eventually permanent loss of vision 
• Brief episodes of blindness, lasting a few seconds and affecting one or both eyes
• Neck, shoulder or back pain
• Underactive parathyroid glands

The doctor would obtain a detailed history, perform a clinical assessment and advise certain tests that would help diagnose pseudotumor cerebri.

• Eye exams: If pseudotumor cerebri is suspected, an ophthalmologist (eye doctor) performs specific tests to test the field of vision and examine the retina and optic nerve.
• Radiological imaging of the brain: The doctor would advise a magnetic resonance imaging (MRI) and/or computed tomography (CT) scan to rule out other causes that present similarly to pseudotumor cerebri, such as brain tumors or blood clots in the brain.
• Lumbar puncture: A lumbar puncture is a procedure in which a small amount of cerebrospinal fluid is removed with a needle inserted in between two vertebrae of the spine in the lower back to measure the pressure inside the skull and analyze the spinal fluid. 

Treatment of pseudotumor cerebri is necessary to improve symptoms and prevent worsening of eyesight, which is the main complication of the condition. Treatment involves mediations, lifestyle modifications and, in some cases, surgery.

Medications

• Glaucoma drugs: These medications are mild diuretics that reduce the production of cerebrospinal fluid and reduce symptoms.
• Other diuretics: Other diuretics may be advised to reduce fluid accumulation by increasing urine output.
• Migraine medications: These reduce the intensity and frequency of headaches that occur in pseudotumor cerebri.

Surgery

• Optic nerve decompression: In this procedure, a surgeon makes a small window in the membrane that surrounds the optic nerve, called the nerve sheath, allowing the excess cerebrospinal fluid to drain out.
• Spinal fluid shunt: The doctor inserts a shunt (a long, thin tube) into the brain or lower spine. The tubing is then placed under the skin of the abdomen, where the shunt drains the excess fluid, hence maintaining intracranial pressure.
• Venous sinus stenting: A stent is placed in one of the larger veins in the head to increase the blood blow in the brain, helping the cerebrospinal fluid circulate, drain and get absorbed better.

Lifestyle modifications: Lifestyle modifications include maintaining an ideal body mass index (BMI) (below 25) by exercising regularly and eating healthy. A low-sodium weight-loss diet may be advised for patients with obesity. Weight loss of even 10 to 15 percent may result in improvement of symptoms.