title: Intracranial Hypertension Is Painless!
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Neurosurgery, University Hospital of Saint-Etienne, Saint-Etienne, France. romain.manet@neurochirurgie.fr.|Service de neurochirurgie, CHU de Saint-Etienne - Hôpital Nord, Avenue Albert Raimond, Saint-Priest-en-Jarez, 42 270, France. romain.manet@neurochirurgie.fr.
authors.forename: R
authors.initials: R
authors.lastname: Manet
authors.affiliation: Department of Neurology, University Hospital of Toulouse, Toulouse, France.
authors.forename: N
authors.initials: N
authors.lastname: Fabre
authors.affiliation: Department of Neurology, University Hospital of Toulouse, Toulouse, France.
authors.forename: E
authors.initials: E
authors.lastname: Moyse
authors.affiliation: Department of Neurosurgery, University Hospital of Saint-Etienne, Saint-Etienne, France.
authors.forename: B
authors.initials: B
authors.lastname: Laurent
authors.affiliation: Department of Neurology, University Hospital of Toulouse, Toulouse, France.
authors.forename: E A
authors.initials: EA
authors.lastname: Schmidt
mesh_terms: D000368:Aged; D005260:Female; D006261:Headache / Q000209:etiology*; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000175:diagnosis; D007263:Infusions, Parenteral / Q000379:methods; D019586:Intracranial Hypertension / Q000150:complications* / Q000209:etiology; D008297:Male; D010147:Pain Measurement; D011446:Prospective Studies; D013129:Spinal Puncture / Q000379:methods
keywords: CSF hydrodynamics; Headache; Infusion tests; Intracranial hypertension; Intracranial pressure; Pain