Intracranial hypertension implies profoundly disturbed intracranial physiology. Although a shared manifestation of myriad neurological disorders of patients admitted in the intensive care unit (ICU), the pathways leading to intracranial hypertension vary by etiology. Acute elevation of the intracranial pressure is an emergency and may rapidly lead to brain death or a devastating neurological outcome if left untreated. Fortunately, with a firm grasp of the underlying pathophysiology and available treatments, one can optimize ICU-based management. Several integrated management paradigms have been used to treat intracranial hypertension. Regrettably, there is a dearth of randomized clinical trials to confirm the efficacy of even our most routine therapeutic strategies.