Is my headache with pressure-like symptoms and increasing tinnitus during caffeine withdrawal unlikely to be caused by intracranial hypotension (low blood pressure in the skull) or intracranial hypertension (high blood pressure in the skull), and why is my tinnitus worsening?

Caffeine Withdrawal Headache: Unlikely to be Intracranial Pressure Disorder

Your pressure-like headache with worsening tinnitus during caffeine withdrawal is almost certainly a caffeine withdrawal headache, not intracranial hypotension or hypertension, because the clinical presentation lacks the defining orthostatic features of intracranial hypotension and the papilledema/visual symptoms of intracranial hypertension.

Why This is Not Intracranial Hypotension

Intracranial hypotension has a pathognomonic orthostatic pattern that you are not describing:

• The hallmark of intracranial hypotension is an orthostatic headache that worsens when upright and dramatically improves within 20 seconds of lying down 1, 2
• Your "pressure-like" headache without this positional component makes intracranial hypotension extremely unlikely 1, 2
• While tinnitus can occur with intracranial hypotension 1, it presents alongside the characteristic postural headache pattern, not in isolation 2
• Intracranial hypotension is rare (5 per 100,000 annually) and typically follows dural puncture or occurs spontaneously in patients with specific risk factors like collagen vascular disease 1

Why This is Not Intracranial Hypertension

Intracranial hypertension presents with distinct features you are not reporting:

• The headache of intracranial hypertension is typically aggravated by the supine position (opposite of hypotension) and accompanied by transient visual obscurations (brief episodes of vision loss) 3
• Pulsatile tinnitus (synchronous with heartbeat) is the characteristic auditory symptom, not general worsening of tinnitus 1, 4, 3
• Papilledema (optic disc swelling) is the clinical hallmark, though it can be absent in some cases 1, 4
• Your pressure-type headache without visual symptoms or pulsatile tinnitus makes this diagnosis highly improbable 1, 4

Why Your Tinnitus is Worsening

Caffeine withdrawal directly causes both headache and changes in cerebral hemodynamics that can worsen tinnitus:

• Caffeine withdrawal produces increased cerebral blood flow velocities in multiple intracranial arteries within 24 hours of abstinence 5
• This hemodynamic change can manifest as increased tinnitus perception alongside the withdrawal headache 5
• The mechanism involves vasodilation and altered cerebral perfusion that reverses within 1-2 hours after caffeine re-intake 5
• Caffeine withdrawal headaches are common, affecting 50% of healthy volunteers in controlled studies, and resolve completely within 1 hour of caffeine consumption 5

Clinical Pitfalls to Avoid

Do not confuse caffeine withdrawal with intracranial pressure disorders:

• The "pressure-like" quality of your headache is non-specific and occurs in both caffeine withdrawal and primary headache disorders 6
• Tinnitus alone, without the pulsatile quality or orthostatic headache pattern, does not indicate an intracranial pressure disorder 1
• The key discriminator is the temporal relationship to caffeine cessation and the absence of orthostatic features 5

Management Approach

For caffeine withdrawal headache with tinnitus:

• Resume caffeine intake, which should resolve both headache and tinnitus within 1-2 hours 5
• If you wish to discontinue caffeine, taper gradually rather than abrupt cessation to minimize withdrawal symptoms 1
• Simple analgesics (NSAIDs or paracetamol) can provide symptomatic relief during withdrawal 1

Red flags requiring urgent evaluation (which you do not have):

• Headache that dramatically worsens when standing and improves when lying flat 1, 2
• Pulsatile tinnitus synchronous with heartbeat 1
• Transient visual obscurations or vision loss 1, 4
• New focal neurological deficits 6