the Differences Between Migraine and Intracranial Hypertension Headaches

Q: the Differences Between Migraine and Intracranial Hypertension Headaches

Hello, Miss： You mentioned that "you were awakened by severe pain in the right occipital region in the early morning," which may need to be considered due to carbon dioxide accumulation causing vasodilation in the brain, leading to increased intracranial pressure. <br>The diagnos

I would like to know the difference between migraine and intracranial hypertension headache?

Hello, I would like to inquire about my hospitalization this year due to headaches.
The attending physician suspected I have migraines.
Initially, they treated me with intracranial pressure management using a medication called Toradol, but it made me nauseous and was ineffective.
After that, I received magnesium sulfate injections for 24 hours, which also did not help.
Eventually, after five consecutive days of ketorolac administered three times a day, my headache was alleviated.
I want to ask about my blood pressure measurements; three years ago it was 200, and this time it was 340.
After a few days, I measured it again and it was 170.
The doctor mentioned that blood pressure can fluctuate, is that true? My headache symptoms start suddenly, progressing from moderate to severe pain.
The pain feels like a sharp, intense blow, not necessarily localized to the top or back of my head.
During the pain, my vision becomes blurry, and I feel nauseous and have vomited multiple times.
An eye examination showed slight swelling of the optic nerve.
I have narrowed cerebral blood vessels, and my cerebral blood flow velocity is 160.
Is this dangerous? Can you tell me what type of headache I have? What is the difference between migraines and headaches due to high intracranial pressure? However, my attending physician believes I am a high intracranial pressure patient, but since my measurements were both high and low, they cannot be certain.
I have been discharged, but I still experience severe headaches frequently, although they are much better than before.
Sometimes my hands and feet feel numb; could this be related to the medication Acetazolamide? Does it help reduce intracranial pressure? After taking it, my head feels heavy; could this be due to other medications? Currently, I am taking medications including mood stabilizers, Seroquel, and Acetazolamide.
Are these all medications that lower intracranial pressure? In the past few days, I have felt a bit dizzy and was awakened in the early morning by severe pain in the right back of my head.
Because of my work, I often have my head down, which causes sharp pain and pressure.
What should I do? The medication has improved things a bit, but I am still in a lot of pain.

Qiao Qiao, 20~29 year old female. Ask Date: 2021/10/26

Dr. Jiang Junyi reply Neurology

Hello, Miss: You mentioned that "you were awakened by severe pain in the right occipital region in the early morning," which may need to be considered due to carbon dioxide accumulation causing vasodilation in the brain, leading to increased intracranial pressure.
The diagnosis of idiopathic intracranial hypertension (IIH) is characterized by cerebrospinal fluid pressure >250 mm CSF (measured via lumbar puncture performed in the lateral recumbent position without sedation, or by measuring the pressure in the epidural space or ventricles).
Your symptoms seem to align with this condition.
However, it is unclear if there are other contributing factors.
You mentioned treatments such as "Prazosin, HCTZ, and Acetazolamide," which have analgesic and intracranial pressure-lowering effects.
Some physicians also prescribe Topiramate as a treatment for intracranial hypertension.
I recommend discussing medication adjustments with your primary physician.
You may also consider consulting a headache specialist for professional advice.
Thank you for your inquiry, and feel free to discuss any related questions! Wishing you good health and peace.
Dr.
Jiang Junyi, Taoyuan Medical Center, cares for you.

Reply Date: 2021/10/26

More Info

Understanding the differences between migraine and intracranial hypertension headaches is crucial for effective diagnosis and treatment. Both conditions can present with severe headaches, but they have distinct characteristics, underlying mechanisms, and treatment approaches.

Migraine is a primary headache disorder characterized by recurrent episodes of moderate to severe headache, often accompanied by nausea, vomiting, and sensitivity to light and sound. The pain is typically unilateral (affecting one side of the head) and can be pulsating in nature. Migraines can have triggers such as stress, certain foods, hormonal changes, and environmental factors. The duration of a migraine attack can range from a few hours to several days. Treatment often includes acute medications like triptans (e.g., sumatriptan) and preventive medications such as beta-blockers, anticonvulsants, or antidepressants.

On the other hand, intracranial hypertension (also known as idiopathic intracranial hypertension or IIH) is a condition where there is increased pressure within the skull without an obvious cause. This can lead to symptoms such as headaches, visual disturbances (like blurred vision), and in some cases, pulsatile tinnitus (ringing in the ears). The headaches associated with IIH are often described as a constant pressure or a "tight band" around the head, and they may worsen with activities that increase intracranial pressure, such as bending over or straining. Diagnosis typically involves measuring cerebrospinal fluid (CSF) pressure via lumbar puncture and may include imaging studies to rule out other causes of increased intracranial pressure.

In your case, the fluctuating intracranial pressure measurements (200 mm CSF, 340 mm CSF, and then 170 mm CSF) suggest that there may be variability in your condition. It is indeed true that CSF pressure can vary based on several factors, including body position, hydration status, and even the time of day. Your symptoms of severe headaches, nausea, and visual disturbances, along with the finding of slight swelling of the optic nerve (papilledema), align more closely with intracranial hypertension rather than typical migraine.

The medications you mentioned—Acetazolamide (Diamox), which is often used to reduce intracranial pressure, as well as other medications like mood stabilizers and possibly diuretics—are appropriate for managing IIH. Acetazolamide works by decreasing the production of cerebrospinal fluid, thereby lowering intracranial pressure. Side effects can include tingling in the extremities, fatigue, and sometimes a feeling of heaviness in the head, which could explain some of your symptoms.

The presence of narrowed blood vessels and elevated blood flow velocity in your brain could indicate underlying vascular issues that may contribute to your headaches. It is essential to monitor these findings closely, as they could pose risks for complications such as stroke or transient ischemic attacks.

Given your complex symptoms and the potential for serious underlying conditions, it is crucial to maintain close communication with your healthcare provider. If you experience worsening symptoms, such as increased headache severity, new neurological deficits (like numbness or weakness), or significant changes in vision, seek immediate medical attention.

In summary, while both migraine and intracranial hypertension can cause severe headaches, they differ significantly in their causes, symptoms, and treatments. Your current treatment plan should be tailored to address the specific nature of your headaches, and ongoing monitoring of your condition is vital. If you have further concerns or if your symptoms persist, consider seeking a second opinion from a headache specialist or a neurologist who can provide more targeted care.

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