Headache attributed to idiopathic intracranial hypertension and persistent post‐idiopathic intracranial hypertension headache: A narrative review

Abstract

Objective Headache is a near‐universal sequela of idiopathic intracranial hypertension (IIH). The aim of this paper is to report current knowledge of headache in IIH and to identify therapeutic options. Background Disability in IIH is predominantly driven by headache; thus, headache management is an urgent and unmet clinical need. At present, there is currently no scientific evidence for the directed use of abortive or preventative headache therapy. Methods A detailed search of the scientific literature and narrative review was performed. Results Headache in IIH is driven by raised intracranial pressure (ICP) and reduction of ICP has been reported in some studies to reduce headache. Despite resolution of papilledema and normalization of raised ICP, a majority suffer persistent post‐IIH headache. The lack of evidence‐based management approaches leaves many untreated. Where clinicians attempt to manage IIH headache, they use off‐label therapies to target the prevailing headache phenotype. A recent prospective open‐label study demonstrated the effective use of a calcitonin gene‐related peptide monoclonal antibody therapy in IIH for persistent post‐IIH headache. Conclusions There is overwhelming evidence of the headache burden in IIH. Studies are required to investigate the biological foundations of headache related to ICP and to develop treatments specifically directed to manage headache in IIH.

The effect of GLP-1RA exenatide on Idiopathic Intracranial Hypertension: Randomised Clinical Trial

“…The hallmark of idiopathic intracranial hypertension is raised ICP which causes headaches and visual loss (through compression of the optic nerve and papilloedema). 10,21,36 Therefore, to evaluate the efficacy of exenatide the primary outcome for this trial was chosen as ICP. 37 A significant reduction in ICP was seen acutely at 2.5 hours of -4.2mmHg (equivalent to -5.7 cmCSF), which corresponds to peak exenatide serum levels.…”

Nuclear Magnetic Resonance Spectroscopy Metabolomics in Idiopathic Intracranial Hypertension to Identify Markers of Disease and Headache

“…The relationship between the IIH specific metabolites and clinical features were then Headache in IIH is initiated by elevated ICP and causes significantly reduced quality of life, yet the underlying mechanism driving pain are not understood. 3,26 We explored the relationship between metabolites and headache morbidity. Obesity is a typical feature of IIH and has been implicated in disease etiology.…”

Outcomes measures in idiopathic intracranial hypertension

“…[30][31] In patients with IIH in whom the pressure has normalized (IIH in ocular remission), persistent post-IIH headaches can remain, contributing to long term morbidity. [31] Both headache attributed to IIH and persistent post-IIH headaches can be exacerbated by co-existing medication overuse. [30][31] There have been no randomised control trials evaluating treatment options for IIH headache, but given the striking similarities to migraine, it should be anticipated that both abortive and preventative therapies should be evaluated in IIH.…”