A woman rubs her temples in pain

At a glance: Idiopathic Intracranial Hypertension

  • Symptoms:

    Headaches, blind spots, peripheral (side) vision loss

  • Diagnosis:

    Dilated eye exam, vision test, other medical tests

  • Treatment:

    Weight loss, medicine, surgery

What is idiopathic intracranial hypertension?

Idiopathic intracranial hypertension (IIH) happens when high pressure around the brain causes symptoms like vision changes and headaches. “Idiopathic” means the cause isn’t known, “intracranial” means in the skull, and “hypertension” means high pressure.

IIH happens when too much cerebrospinal fluid (CSF) — the fluid around the brain and spinal cord — builds up in your skull. This puts extra pressure on your brain and on the nerve in the back of your eye, called the optic nerve.

If you notice changes in your vision, talk to your eye doctor. The doctor can figure out if your symptoms are related to IIH or another condition. If it’s IIH, there are treatments that can help with the symptoms.

What are the symptoms of IIH?

Symptoms can include:

  • Headaches
  • Tinnitus (ringing in the ears)
  • Temporary blindness
  • Double vision
  • Blind spots
  • Neck and shoulder pain
  • Peripheral (side) vision loss

If you notice any changes to your vision or other symptoms, talk to your eye doctor.

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Did you know?

IIH symptoms are often similar to the symptoms of a brain tumor — so IIH is sometimes called pseudotumor cerebri, or “false tumor.”

About 19 out of 20 people with IIH are women.

Am I at risk for IIH?

IIH is rare, but some people are at higher risk. It’s most common in women ages 20 to 50.

Being overweight or obese also makes IIH more likely. You may be at higher risk if you have a body mass index (BMI) greater than 30, or if you recently gained weight. You can calculate your BMI using CDC’s online calculator.

What causes IIH?

Experts don’t know what causes IIH. But there are other types of intracranial hypertension that do have known causes:

  • Acute intracranial hypertension happens suddenly, usually because of an accident or stroke
  • Chronic intracranial hypertension develops over time, usually because of a health problem like a blood clot or brain tumor, or from taking certain medicines

If doctors can’t find a reason for the high pressure, it’s called IIH.

How will my eye doctor check for IIH?

Your eye doctor will do several tests to check for signs of IIH, including a dilated eye exam to look at the back of your eye and a visual field test to check your peripheral vision.

Your eye doctor may also want you to see a neurologist (a doctor specializing in the brain). The neurologist will check to make sure your symptoms aren’t happening because of another health problem, like a brain tumor. The neurologist may do tests including:

  • A physical exam
  • Brain imaging, like a CT or MRI scan
  • A spinal tap (lumbar puncture) to test your CSF

What's the treatment for IIH?

For most people, IIH symptoms get better with treatment. Treatments include:

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Weight loss. For people who are overweight or obese and have IIH, weight loss is usually the first treatment. Losing about 5 to 10 percent of your body weight can help lessen your symptoms — for example, if you weigh 200 pounds, that means losing about 10 to 20 pounds. Talk with your doctor about safe, sustainable ways to lose weight.

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Medicine. Your doctor may recommend a medicine called acetazolamide (Diamox) in addition to weight loss. This medicine helps your body make less CSF.

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Surgery. If other treatments don’t work, your doctor might suggest surgery to help relieve the pressure. In shunt surgery, doctors make a small hole and add a thin tube, called a shunt, to help extra fluid drain from around your brain into the rest of your body. There is also an eye surgery where doctors make a small hole in the covering around the optic nerve.

What's the latest research on IIH?

Researchers are studying what causes IIH, including how genes and hormones might play a role.

In 2010, NEI funded a clinical trial to test the medicine acetazolamide (Diamox) in IIH patients with mild vision loss. This trial helped to prove that acetazolamide, along with a weight loss plan, can help to restore some vision in people with IIH. It also helped create clear guidelines for doctors on how to prescribe acetazolamide for patients with IIH.  

Read more about IIH clinical trials on NIH’s clinical trials website.

Last updated: September 22, 2020