Pressure Headache – Perception or Compression?

The are a number of common terms used to describe the type of pain experienced in a headache. Commonly, a pressure headache is pain which is accompanied by the feeling of increased pressure in an area. It may or may not be associated with actual congestion in a specific part of the body, within a cavity or pressure on an organ.

In this instance, the term ‘pressure’ is used solely to describe the sensation which may also be described as congested, expanding or stretching. A tension-type headache may at times feel like a pressure on certain parts of the head, yet it may not be associated with an increase in pressure on or within an organ (compression or congestion).

A headache due to an increase in pressure in the head causes compression or stretching of nerves or tissue and may be a result of :

  • a solid mass
  • fluid accumulation (CSF, blood) or swelling
  • changes in air pressure

In this instance, the increase in pressure (compression) results in a headache and the pain sensation may differ among individuals. It will not always be perceived as ‘pressure’ or compression.

Causes of a Headache due to Increased Pressure

It is generally accepted that increased pressure within the body, a cavity, organ or tissue, will lead to pain due to the force exerted on surrounding nerve fibers, activation of pressure and pain receptors as well as the stretching of the surrounding tissue.

Intracranial Pressure

The brain itself is insensitive to pain. However, the surrounding areas like meninges (brain lining), blood vessels (especially the middle meningeal artery) and venous sinuses around the brain, are sensitive to pain. Pressure on the cranial or cervical nerves may also result in pain.

It is often difficult to isolate the exact location of the pain within the head due to the number of structures within the cranial cavity and the brain’s insensitivity to pain. Read more on pressure on the brain.

Cerebral Vault Headache

Any compression that activates the pain receptors above the tentorium cerebelli, where the cerebrum is housed, will cause a frontal headache as a result of referred pain via the trigeminal nerve (CN V / cranial nerve 5).This includes the area in front of and above the ear (temples) and forehead.

Cerebellar Vault Headache

Compression that activates the pain receptors below the tentorium where the cerebellum and brain stem is housed will cause a the rear (posterior) half of the head as a result of referred pain via glossopharyngeal nerve (CN IX), vagus nerve (CN X) or second cervical (neck) nerve (occipital nerve). This includes the area above, behind and slightly below the ear and pain at the back of the head.

Cerebrospinal Fluid Pressure

The brain is surrounded by cerebrospinal fluid (CSF) and an increase in volume will raise the pressure against the meninges and result in a headache. A decrease in CSF volume (after a lumbar tap, CSF rhinorrhea or otorrhea), will also elicit pain as the brain can no longer float freely of the meninges and may compress it

Hemorrhage

Bleeding around the brain or within the brain will increase the intracranial pressure and result in a headache. This includes :

  • intracerebral hemorrhage
  • subdural hematoma
  • subarachnoid hemorrhage
  • ruptured aneurysm

The conditions that may cause these headaches are mentioned in :

Extracranial Pressure

Sinus Pressure Headache

Infection or irritation of the sinus linings or congestion of the nasal sinuses usually cause facial pain and/or a headache.

Congestion of the frontal sinuses may cause pain :

  • behind the eyes
  • forehead

Congestion of the sphenoid sinuses may cause pain :

  • behind the eyes
  • temples
  • top of the head

Congestion of the ethmoid sinuses may cause pain :

  • around or behind the eyes

Congestion of the maxillary sinuses may cause pain :

  • face, particularly the cheeks
  • sometimes behind the eye

Other symptoms, apart from the sinus headache or facial pain, may also be evident including nasal congestion and/or discharge.

Eye Pressure Headache

Some of the causes of a headache associated with pressure on or in the eye includes :

  • Glaucoma which is the increased pressure within the eye.
  • Orbital cellulitis is the infection of the tissue around the eye or behind the eye (retro-orbital cellulitis). The swelling may impinge on the optic nerve.

Other symptoms may also be evident including blurred vision and puffiness around the eye or on the eyelid.

Blood Pressure Headache

Hypertensive patients may report a headache in association with an increase in blood pressure, however, there is no significant evidence to suggest that headaches and moderate hypertension are linked. However, extreme elevation of the blood pressure may cause swelling of the brain and result in headaches.

Barometric Pressure Headache

Changes in the air pressure, which coincides with changes in weather, are a known migraine trigger. This includes an increase or decrease in barometric pressure, although low barometric pressure appears to coincide with non-migraine headaches.


Article reviewed by Dr. Greg. Last updated on April 8, 2011