Uncontrolled intracranial hypertension is an important cause of mortality and morbidity in severely head injured patients. Monitoring intracranial pressure (ICP) and controlling intracranial hypertension are essential in preventing herniation and avoiding ischemic secondary brain injury. Head injured patients may require specific ICP treatment to maintain it below 20 to 25 mmHg and improve cerebral perfusion pressure (CPP) above 70 mmHg. The optimal values of ICP and CPP are vary among patients and over time. A basic goal of neurotrauma intensive care is to develop methods for treatment the various traumatic cerebral conditions for individual patients. Various methods to controlling ICP have evolved over the past two decades. Most of these therapeutic maneuvers are critical to optimizing outcomes beyond simply lowering ICP. Continuous ICP monitoring reflects the brain decompensation, allowing early detection of herniation. The present article aims to define the roles of ICP and CPP monitoring as a methods of the ICP reduction therapy after severe brain injury.