Table of ContentsView AllTable of ContentsWhat Is ICP?SymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
What Is ICP?
Symptoms
Causes
Diagnosis
Treatment
Pressure in the head when lying down that is relieved when upright is a symptom of elevatedintracranial pressure(ICP). This is when pressure in the brain and surrounding cerebrospinal fluid increases to the point that it can cause severe brain damage and even be fatal.
This article explains elevated intracranial pressure, its common symptoms, and possible complications. It also discusses the causes of increased intracranial pressure and how it is treated.
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What Is Elevated Intracranial Pressure?
Intracranial means within the skull. In addition to brain tissue, the skull containscerebrospinal fluid(CSF), which encases and cushions the brain, and blood that supplies the brain with oxygen while ridding it of toxins.
Intracranial pressure rises when one of these three components—brain tissue, CSF, and blood—requires more space.
Elevated ICP Symptoms
One of the first structures to feel the strain of increased ICP is the tissue known as meninges that surround the brain. Whereas the brain itself lacks pain receptors, the meninges can fire off pain messages that result in a terrible headache.
Classic signs of intracranial pressure include a headache and/or the feeling of increased pressure when lying down and relieved pressure when standing.
Other symptoms of elevated intracranial pressure include:
Pressure in Your Head: Causes and Relief
Visual Symptoms
The optic nerves are also commonly affected, most especially the nerves that travel from the back of the eye (retina) to the occipital lobes of the brain. Depending on the severity and duration of the increased pressure, visual symptoms can include:
Papilledemais a condition in which increased intracranial pressure causes part of the optic nerve to swell. Symptoms include fleeting disturbances in vision, headache, and vomiting.
Complications
Even more concerning than optic nerve damage is how ICP can impact the brain itself. When pressure rises inside the skull, the brain can be pushed to an area of lower pressure.
If a bleed in the left hemisphere creates enough pressure, it can push the left hemisphere under the falx cerebri, crushing brain tissue and blocking off blood vessels. Brain damage andstrokecan result.
This can lead to paralysis,coma, and even death.
What Causes Elevated ICP?
There are several things that can trigger an increase in intracranial pressure. These include abrain tumor, an active bleed in the brain, or an infection that causes massive inflammation and even the production of pus.
At other times, the normal flow of fluids in and out of the brain is impeded. CSF, for example, normally flows from the ventricles in the center of the brain through small openings known as foramina. If the flow is blocked, intracranial pressure can build.
Some of the more common causes of elevated ICP include:
Sometimes, the cause of the increased intracranial pressure is unknown. This is referred to as idiopathic elevated intracranial pressure.
Elevated intracranial pressure may be diagnosed in a number of different ways. In addition to an evaluation of symptoms, a fundoscopic exam of the eye may reveal papilledema.
Aspinal tap (lumbar puncture)may also provide information about intracranial pressure, particularly if there is an infection, although this can be dangerous if pressure is extremely high.
The most reliable means of measuring ICP is with an intracranial monitor, using either anintraventricular catheterinserted into the CSF layer, asubdural boltplaced adjacent to the cerebral membrane, or anepidural sensorplaced outside of the membrane.
An intracranial monitor requires surgical insertion through a drilled hole in the skull. With some brain surgeries or atraumatic brain injury, an intracranial monitor may be placed immediately.
The Differences Between Head Injury and a Traumatic Brain Injury
Elevated intracranial pressure can be dangerous. The first goal is to stabilize a patient, provide sedation if needed, and relieve the pain. If the ICP is mildly elevated, a watch-and-wait approach with the elevation of the head may be all that is needed.
In more severe cases, the doctor may use mannitol (a type of sugar alcohol) or hypertonic saline (a salt solution) to draw the excess fluid into the bloodstream and away from the brain.
Intravenous steroids may help decrease cerebral inflammation. Medications like acetazolamide may slow the production of cerebrospinal fluid.
Intracranial pressure over 20 mmHg is treated aggressively. Treatments may include hypothermia (to cool the body and reduce swelling), the anestheticpropofolto suppress metabolism, or a surgery called a craniectomy to relieve brain pressure.
A Word From VerywellSince there are many causes of elevated intracranial pressure, there can be variability in the timing of onset and how it appears in a young child vs. a grown adult. Knowing some of the signs and symptoms of elevated intracranial pressure can lead to early detection, prompt resolution, and even prevent long-lasting complications.—NICHOLAS R. METRUS, MD, MEDICAL EXPERT BOARD
A Word From Verywell
Since there are many causes of elevated intracranial pressure, there can be variability in the timing of onset and how it appears in a young child vs. a grown adult. Knowing some of the signs and symptoms of elevated intracranial pressure can lead to early detection, prompt resolution, and even prevent long-lasting complications.—NICHOLAS R. METRUS, MD, MEDICAL EXPERT BOARD
Since there are many causes of elevated intracranial pressure, there can be variability in the timing of onset and how it appears in a young child vs. a grown adult. Knowing some of the signs and symptoms of elevated intracranial pressure can lead to early detection, prompt resolution, and even prevent long-lasting complications.
—NICHOLAS R. METRUS, MD, MEDICAL EXPERT BOARD
6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Friedman DI.Headaches due to low and high intracranial pressure.Continuum (Minneap Minn).2018;24(4, Headache):1066-1091. doi:10.1212/CON.0000000000000623Meyfroidt G, Bouzat P, Casaer MP, et al.Management of moderate to severe traumatic brain injury: an update for the intensivist.Intensive Care Med. 2022;48(6):649–66. doi:10.1007/s00134-022-06702-4Czosnyka M, Pickard J, Steiner L.Principles of intracranial pressure monitoring and treatment.Handbook of Clinical Neurology. 2017;140:67-89. doi:10.1016/B978-0-444-63600-3.00005-2Rigi M, Almarzouqi SJ, Morgan ML, Lee AG.Papilledema: Epidemiology, etiology, and clinical management.Eye Brain. 2015;7:47–57. doi:10.2147/EB.S69174de Oliveira Manoel A, Goffi A, Zampieri F, et al.The critical care management of spontaneous intracranial hemorrhage: A contemporary review.Critical Care. 2016;20:272. doi:10.1186/s13054-016-1432-0Hawryluk GWJ, Citerio G, Hutchinson P, et al.Intracranial pressure: current perspectives on physiology and monitoring.Intensive Care Med. 2022;48(10):1471–81. doi:10.1007/s00134-022-06786-yAdditional ReadingKasper DL, Fauci AS, Hauser SL. Harrison’s Principles of Internal Medicine. New York: Mc Graw-Hill Education. Print.
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Friedman DI.Headaches due to low and high intracranial pressure.Continuum (Minneap Minn).2018;24(4, Headache):1066-1091. doi:10.1212/CON.0000000000000623Meyfroidt G, Bouzat P, Casaer MP, et al.Management of moderate to severe traumatic brain injury: an update for the intensivist.Intensive Care Med. 2022;48(6):649–66. doi:10.1007/s00134-022-06702-4Czosnyka M, Pickard J, Steiner L.Principles of intracranial pressure monitoring and treatment.Handbook of Clinical Neurology. 2017;140:67-89. doi:10.1016/B978-0-444-63600-3.00005-2Rigi M, Almarzouqi SJ, Morgan ML, Lee AG.Papilledema: Epidemiology, etiology, and clinical management.Eye Brain. 2015;7:47–57. doi:10.2147/EB.S69174de Oliveira Manoel A, Goffi A, Zampieri F, et al.The critical care management of spontaneous intracranial hemorrhage: A contemporary review.Critical Care. 2016;20:272. doi:10.1186/s13054-016-1432-0Hawryluk GWJ, Citerio G, Hutchinson P, et al.Intracranial pressure: current perspectives on physiology and monitoring.Intensive Care Med. 2022;48(10):1471–81. doi:10.1007/s00134-022-06786-yAdditional ReadingKasper DL, Fauci AS, Hauser SL. Harrison’s Principles of Internal Medicine. New York: Mc Graw-Hill Education. Print.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Friedman DI.Headaches due to low and high intracranial pressure.Continuum (Minneap Minn).2018;24(4, Headache):1066-1091. doi:10.1212/CON.0000000000000623Meyfroidt G, Bouzat P, Casaer MP, et al.Management of moderate to severe traumatic brain injury: an update for the intensivist.Intensive Care Med. 2022;48(6):649–66. doi:10.1007/s00134-022-06702-4Czosnyka M, Pickard J, Steiner L.Principles of intracranial pressure monitoring and treatment.Handbook of Clinical Neurology. 2017;140:67-89. doi:10.1016/B978-0-444-63600-3.00005-2Rigi M, Almarzouqi SJ, Morgan ML, Lee AG.Papilledema: Epidemiology, etiology, and clinical management.Eye Brain. 2015;7:47–57. doi:10.2147/EB.S69174de Oliveira Manoel A, Goffi A, Zampieri F, et al.The critical care management of spontaneous intracranial hemorrhage: A contemporary review.Critical Care. 2016;20:272. doi:10.1186/s13054-016-1432-0Hawryluk GWJ, Citerio G, Hutchinson P, et al.Intracranial pressure: current perspectives on physiology and monitoring.Intensive Care Med. 2022;48(10):1471–81. doi:10.1007/s00134-022-06786-y
Friedman DI.Headaches due to low and high intracranial pressure.Continuum (Minneap Minn).2018;24(4, Headache):1066-1091. doi:10.1212/CON.0000000000000623
Meyfroidt G, Bouzat P, Casaer MP, et al.Management of moderate to severe traumatic brain injury: an update for the intensivist.Intensive Care Med. 2022;48(6):649–66. doi:10.1007/s00134-022-06702-4
Czosnyka M, Pickard J, Steiner L.Principles of intracranial pressure monitoring and treatment.Handbook of Clinical Neurology. 2017;140:67-89. doi:10.1016/B978-0-444-63600-3.00005-2
Rigi M, Almarzouqi SJ, Morgan ML, Lee AG.Papilledema: Epidemiology, etiology, and clinical management.Eye Brain. 2015;7:47–57. doi:10.2147/EB.S69174
de Oliveira Manoel A, Goffi A, Zampieri F, et al.The critical care management of spontaneous intracranial hemorrhage: A contemporary review.Critical Care. 2016;20:272. doi:10.1186/s13054-016-1432-0
Hawryluk GWJ, Citerio G, Hutchinson P, et al.Intracranial pressure: current perspectives on physiology and monitoring.Intensive Care Med. 2022;48(10):1471–81. doi:10.1007/s00134-022-06786-y
Kasper DL, Fauci AS, Hauser SL. Harrison’s Principles of Internal Medicine. New York: Mc Graw-Hill Education. Print.
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