Advances in the understanding of headache in idiopathic intracranial hypertension

Abstract

Purpose of review To review the most relevant developments in the understanding of headache in idiopathic intracranial hypertension (IIH). Recent findings The phenotype of the typical IIH headache is diverging from the historical thinking of a raised intracranial pressure headache, with the majority being classified as having migraine. A larger proportion of those with IIH have a past medical history of migraine, compared with the general population, highlighting the importance of reexamining those who have a change or escalation in their headache. The mechanisms underlying headache in IIH are not understood. Additionally, factors which confer a poor headache prognosis are not established. It is clear, however, that headache has a detrimental effect on all aspects of the patient's quality of life and is currently ranked highly as a research priority by IIH patients to better understand the pathophysiology of headache in IIH and identification of potential headache specific therapeutic agents. Summary Headache remains the predominate morbidity in the majority of those with IIH. Headache management is an unmet need in IIH and future studies are required to investigate the probable complex mechanisms, as well as effective management.

Calcitonin gene related peptide monoclonal antibody treats headache in patients with active idiopathic intracranial hypertension

“…Disability in IIH is predominantly driven by debilitating headache [3]. Headaches in IIH most frequently have migrainelike characteristics [4]. Therapeutic strategies to prevent headache in IIH are an unmet need [1,4,5].…”

Calcitonin gene related peptide monoclonal antibody treats headache in patients with active idiopathic intracranial hypertension

“…The mechanisms driving headache in patients with IIH have not been elucidated and treatment approaches are lacking. (1,4,5) Headaches in IIH are typically chronic migraine-like, drive disability and are a patient prioritised key area for mechanistic research and treatment. (3,4,8) CGRP is a key modulator of migraine headaches(9) and this case series provides evidence for the role of CGRP as an important nociceptive stimulus in IIH headaches.…”

“…(1,4,5) Headaches in IIH are typically chronic migraine-like, drive disability and are a patient prioritised key area for mechanistic research and treatment. (3,4,8) CGRP is a key modulator of migraine headaches(9) and this case series provides evidence for the role of CGRP as an important nociceptive stimulus in IIH headaches. The therapeutic reduction of headache was noted in IIH patients in ocular remission, but more importantly also during the subsequent phase of recurrent active IIH, suggesting that headaches driven by raised ICP may involve CGRP release.…”

“…Their headaches persisted, even after resolution of papilledema, and had migraine-like characteristics (photophobia, phonophobia, kinesophobia, nausea and throbbing pain) as is typical in IIH. (1,4,6) The mean (SD) duration of years since the IIH diagnosis was 2.4 (1.5). Their headaches persisted (> 15 days per month) and were resistant to conventional oral preventative treatments (failed > 3).…”

“…(4) Therapeutic strategies to prevent headache in IIH are an unmet need. (1,4,5) We report seven patients with IIH whose presenting feature for raised ICP was headache. These headaches persisted despite resolution of papilloedema and had migraine-like characteristics.…”