From the Guidelines
Headache is not a typical prominent symptom of Normal Pressure Hydrocephalus (NPH), but it can occur in some cases, usually described as dull, generalized, and of low intensity. NPH is primarily characterized by the triad of gait disturbance, urinary incontinence, and cognitive decline. The provided evidence, although focused on idiopathic intracranial hypertension (IIH), suggests that headaches in conditions related to increased intracranial pressure can be managed with standard headache treatments, but under medical supervision due to the complex nature of these conditions 1.
Understanding NPH and Headaches
The reason headaches are not a major feature of NPH is that the pressure increase is gradual, allowing the brain to adapt over time, unlike in acute hydrocephalus where sudden pressure increases often cause severe headaches. If a patient with suspected NPH experiences severe or worsening headaches, it may indicate a complication or a different diagnosis, and they should be evaluated promptly.
Management of NPH and Headaches
Management of NPH typically focuses on addressing the primary symptoms through CSF diversion procedures like ventriculoperitoneal shunting, rather than treating headaches specifically. For any headaches that do occur, standard headache treatments can be used, but always under medical supervision due to the complex nature of NPH. The evidence from IIH management suggests caution with potential side effects of NSAIDs and advises against the use of opioids for headaches 1.
Considerations for Treatment
Given the complex nature of NPH and its distinction from conditions like IIH, it's crucial to approach headache management with caution, considering the potential for medication overuse headache and the limited evidence supporting certain treatments for headache alone in conditions with increased intracranial pressure 1. Adjustable valves with antigravity or antisiphon devices should be considered for use to reduce the risk of low-pressure headaches in patients undergoing CSF diversion procedures, as suggested for IIH management 1.
Conclusion on Headache Management in NPH
In summary, while headache is not a defining symptom of NPH, its management should be approached with caution, considering the underlying condition's complexity and the potential for complications. Standard headache treatments under medical supervision and addressing the primary symptoms of NPH through appropriate CSF diversion procedures are key aspects of managing patients with NPH who experience headaches.
From the Research
Normal Pressure Hydrocephalus (NPH) Symptoms
- Headache is not explicitly mentioned as a common symptom in most studies on NPH, except in one study that discusses symptoms suggestive of raised intracranial pressure, which includes headache 2.
- The classic triad of NPH symptoms includes gait disturbances, urinary incontinence, and cognitive changes 3, 4.
- Other symptoms that may be associated with NPH include nausea, visual disturbance, and systemic hypertension 2.
Relationship Between Headache and NPH
- One study suggests that new-onset systemic hypertension may be a clinical sign of NPH, and some patients with NPH may experience symptoms suggestive of raised intracranial pressure, including headache 2.
- Another study discusses headache in the context of increased cerebrospinal fluid pressure, but does not specifically address NPH 5.
- There is limited evidence to suggest that headache is a common symptom of NPH, but it may be associated with raised intracranial pressure in some cases 2, 5.