Intracranial Hypertension Is Painless!

  • R. ManetEmail author
  • N. Fabre
  • E. Moyse
  • B. Laurent
  • E. A. Schmidt
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 122)


Introduction: Headache is usually considered a key symptom of intracranial hypertension (ICHT). However, there are no published experimental data to support the concept that increased intracranial pressure (ICP) is painful in humans. Materials and Methods: This prospective study was performed in 16 patients with suspected normal-pressure hydrocephalus, necessitating a lumbar infusion test with measurement of cerebrospinal fluid (CSF) hydrodynamics. During the test, ICP was increased from baseline to a plateau. Headache was scored on a visual analog scale (VAS) (0 = no pain, 10 = very severe pain) at baseline ICP and when ICP plateaued. Results: At baseline, mean ICP was 11 ± 3.6 mmHg and VAS was 0. At plateau, mean ICP was 28 ± 9.5 mmHg and VAS was 0. There was a significant increase in ICP (p <0.001), but no increase in headache intensity (VAS). An acute (20-min) moderate increase in ICP was not accompanied by a headache. Discussion: We demonstrate that an acute, isolated increase in CSF pressure does not produce a headache. To occur, a headache needs activation of the pain-sensitive structures (dura and venous sinuses) or central activation of the cerebral nociceptive structures. This peripheral or central activation does not occur with an isolated increase in CSF pressure.


Intracranial hypertension Intracranial pressure Pain Headache CSF hydrodynamics Infusion tests 


Conflict of Interest



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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • R. Manet
    • 1
    • 2
    Email author
  • N. Fabre
    • 3
  • E. Moyse
    • 3
  • B. Laurent
    • 1
  • E. A. Schmidt
    • 3
  1. 1.Department of NeurosurgeryUniversity Hospital of Saint-EtienneSaint-EtienneFrance
  2. 2.Service de neurochirurgieCHU de Saint-Etienne – Hôpital NordSaint-Priest-en-JarezFrance
  3. 3.Department of NeurologyUniversity Hospital of ToulouseToulouseFrance

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