One of my patients complains of a constant throbbing headache which is worse in the morning and when she coughs. She often feels sick and has noticed that her vision fades for a few seconds before becoming normal again. She is 25 years old and is very overweight. What is going on?

This has all the signs of chronic raised intracranial pressure.

This is a build-up of pressure around the brain and in the chronic form is rare and sometimes it’s not clear why it happens.

Symptoms can include:

Constant throbbing headache which may be worse in the morning, or when coughing or straining; it may improve when standing up

Temporary loss of vision –it may become dark or grey for a few seconds; this can be triggered by coughing, sneezing or bending down

Feeling and being sick

Feeling sleepy

Feeling irritable.

There may be a sudden onset unilateral esotropia (inward eye turn) as pressure is put on the sixth cranial nerve.

There is a danger of optic nerve atrophy because of pressure on the optic nerve.

When the cause is unclear it is called idiopathic intracranial hypertension. This commonly occurs in overweight women between 20 and 30 years old.

This patient needs to be referred to their general practitioner and then to a neurologist.