Headache in idiopathic intracranial hypertension. A CGRP-dependent head pain?

Simone, Roberto De; Sansone, Mattia; Bonavita, V.

doi:10.1007/s10072-020-04641-w

Cited by 15 publications

(16 citation statements)

References 38 publications

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“…Turning to headache outcome, improvement of headache frequency and/or severity was achieved in more than 80% of patients after one year of treatment in our cohort, while some degree of headache persisted in about three quarters of patients, both well in line with existing literature [24][25][26][27]. Studies investigating predictors of headache outcome in IIH are generally very scarce as most focus on visual outcome, likely because visual impairment is often considered more relevant and is also easier to measure in clinical practice.…”

Section: Discussionsupporting

confidence: 89%

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MRI features of idiopathic intracranial hypertension are not prognostic of visual and headache outcome

Bsteh

Marik

Krajnc

et al. 2023

Preprint

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Background: In idiopathic intracranial hypertension (IIH), certain MRI features are promising diagnostic markers, but whether these have prognostic value is currently unknown. Methods: We included patients from the Vienna-Idiopathic-Intracranial-Hypertension (VIIH) database with definitive IIH according to Friedman criteria and cranial MRI performed at diagnosis. Presence of empty sella (ES), optic nerve sheath distension (ONSD), optic nerve tortuosity (ONT), posterior globe flattening (PGF) and transverse sinus stenosis (TSS) was assessedand multivariable regression models regarding visual outcome (persistent visual impairment/visual worsening) and headache outcome (headache improvement/freedom of headache) were fitted. Results: We included 84 IIH patients (88.1% female, mean age 33.5 years, median body mass index 33.7). At baseline, visual impairment was present in 70.2% and headache in 84.5% (54.8% chronic). Persistent visual impairment occurred in 58.3%, visual worsening in 13.1%, headache improvement was achieved in 83.8%, freedom of headache in 26.2%. At least one MRI feature was found in 78.6% and 60.0% had ≥3 features with ONSD most frequent (64.3%) followed by TSS (60.0%), ONT (46.4%), ES (44.0%) and PGF (23.8%). In multivariable models, there was no association of any single MRI feature or their number with visual impairment, visual worsening, headache improvement or freedom. Visual impairment at baseline predicted persistent visual impairment (odds ratio 6.3, p<0.001), but not visual worsening. Chronic headache at baseline was significantly associated with lower likelihood of headache freedom (odds ratio 0.48, p=0.013), but not with headache improvement. Conclusions: MRI features of IIH are neither prognostic of visual nor headache outcome.

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Section: Discussionsupporting

confidence: 89%

“…Disappointingly, the investigated MRI features of IIH did not provide any independent prognostic information regarding headache improvement or freedom. It is well known that headache in IIH is not su ciently explained by raised ICP alone [26,27,31].…”

Section: Discussionmentioning

confidence: 99%

MRI features of idiopathic intracranial hypertension are not prognostic of visual and headache outcome

Bsteh

Marik

Krajnc

et al. 2023

Preprint

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“…Raised ICP is not the only factor involved in headache development, as more than half of patients with IIH (pwIIH) continue experiencing headaches after resolution of papilledema and normalization of CSF pressure. [5][6][7][8] Risk factors propagating persistent headache are largely unknown, but it is hypothesized that some degree of migraine predisposition may be required for headache to develop in pwIIH potentially also modulating its frequency and severity. 5,6 Migraine biology may even be the driving force behind IIH headache chronification.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7][8] Risk factors propagating persistent headache are largely unknown, but it is hypothesized that some degree of migraine predisposition may be required for headache to develop in pwIIH potentially also modulating its frequency and severity. 5,6 Migraine biology may even be the driving force behind IIH headache chronification. 6 Chronic migraine and IIH share main risk factors and calcitonin gene-related peptide monoclonal antibodies have been shown to improve headache persisting after resolution of papilledema in pwIIH.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 Migraine biology may even be the driving force behind IIH headache chronification. 6 Chronic migraine and IIH share main risk factors and calcitonin gene-related peptide monoclonal antibodies have been shown to improve headache persisting after resolution of papilledema in pwIIH. [9][10][11] In this light, we aimed to investigate whether migraine headache at IIH diagnosis has prognostic impact by comparing pwIIH with and without migraine phenotype.…”

Section: Introductionmentioning

confidence: 99%

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Idiopathic intracranial hypertension presenting with migraine phenotype is associated with unfavorable headache outcomes

et al. 2023

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Objective To assess the prognostic impact of migraine headache in idiopathic intracranial hypertension (IIH). Background Migraine headache is common in IIH, but it is unclear whether it has prognostic relevance. Methods We investigated patients with IIH from the Vienna‐IIH‐database and differentiated migraine (IIH‐MIG) from non‐migraine headache (IIH‐nonMIG) and without headache (IIH‐noHA). Using multivariable models, we analyzed the impact of IIH‐MIG on headache and visual outcomes 12 months after diagnosis. Results Among 97 patients (89% female, mean [SD] age 32.9 [11.1] years, median body mass index 32.0 kg/m2, median cerebrospinal fluid opening pressure 310 mm), 46% were assigned to IIH‐MIG, 37% to IIH‐nonMIG (11% tension‐type, 26% unclassifiable), and 17% to IIH‐noHA. Overall, headache improvement was achieved in 77% and freedom of headache in 28%. The IIH‐MIG group showed significantly lower rates for headache improvement (67% vs. 89% in IIH‐nonMIG, p = 0.019) and freedom of headache (11% vs. 33% in IIH‐nonMIG and 63% in IIH‐noHA, p = 0.015). These differences persisted when only analyzing patients with resolved papilledema at follow‐up. In contrast, visual worsening was significantly less common in IIH‐MIG (9% vs. 28% in IIH‐nonMIG and 31% in IIH‐noHA, p = 0.045). In multivariable models, IIH‐MIG was associated with a significantly lower likelihood of achieving headache improvement (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.40–0.78, p < 0.001) and freedom of headache (OR 0.29, 95% CI 0.12–0.46, p < 0.001), but also a lower risk for visual worsening (OR 0.26, 95% CI 0.04–0.82, p < 0.001). Conclusions In IIH, migraine headache is associated with unfavorable outcomes for headache, even when papilledema has resolved, and possibly favorable visual outcome.

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Predictors of disease course and long-term outcomes of idiopathic intracranial hypertension in children and adolescents

Senderowich,

Bachar-Zipori,

Mitelpunkt

et al. 2023

Eur J Pediatr

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Headache in idiopathic intracranial hypertension. A CGRP-dependent head pain?

Cited by 15 publications

References 38 publications

MRI features of idiopathic intracranial hypertension are not prognostic of visual and headache outcome

MRI features of idiopathic intracranial hypertension are not prognostic of visual and headache outcome

Idiopathic intracranial hypertension presenting with migraine phenotype is associated with unfavorable headache outcomes

Predictors of disease course and long-term outcomes of idiopathic intracranial hypertension in children and adolescents

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