Headache prevalence and clinical features in patients with idiopathic intracranial hypertension (IIH)

Abstract

Headache is a key symptom of idiopathic intracranial hypertension (IIH). Operational diagnostic criteria for ''Headache attributed to IIH'' are included in the international classification of headache disorders, the ICHD-2. The association of IIH with obesity was established by several reports. We investigate the prevalence of headache and its main clinical features in a clinical sample of IIH patients. The possible correlations between the presence of headache and body mass index (BMI) and intracranial pressure (ICP) levels were studied in a consecutive clinical series of patients, in whom diagnosis of IIH was confirmed by exclusion of secondary forms and by the evidence of increased ICP. Differences for age, BMI, and ICP between patients with and without headache and between males and females were assessed with MannWhitney U test. Spearman's correlation analysis was used to assess relationships between age, BMI, and ICP. P value \ 0.05 was used to set statistical significance. 40 patients entered the study (9 males, 31 females; mean age 39, 8 years, SD 13.2). Headache was reported by 75 % patients. Those characteristics which are included in the present international diagnostic criteria for ''Headache attributed to IIH'' were reported by a remarkable proportion of the studied patients, but not by all. On the other hand, some headache features usually attributed to migraine forms, and which are not among the required criteria were present in some patients: pulsating quality and unilateral distribution of pain in around 20 %, and migrainous associated symptoms in more than 40 % of the sample. According to statistical analyses, no differences were found for age, BMI, and ICP between patients with and without headache. Our results confirmed the strong association between headache and IIH. Although no significant correlations between some of the key features of IIH were found in this study, we suggest that further studies on larger series-possibly with a longitudinal evaluation-are needed, to help clinicians in categorizing different subgroups among IIH patients as well as in identifying the main factors influencing the prognosis of this disorder.

Headache in Idiopathic Intracranial Hypertension: Findings From the Idiopathic Intracranial Hypertension Treatment Trial

“…A recent study looking at the applicability of the ICHD-3b criteria found that 84% of IIH patients had focal or unilateral headaches, 52% had pulsatile pain, and a majority of patients had aggravation with cough or Valsalva maneuvers 16 . A series of prospective studies of patients with IIH have reported contradictory headache characteristics including daily or near-daily headache, diffuse/non-pulsating pain, aggravation with Valsalva maneuvers, unilateral pain, and migraine-associated symptoms 9 as well as pulsatile pain and no aggravation with valsalva 1,3 . These findings illustrate the varied headache qualities amongst patients with IIH at presentation.…”

“…Headache was the most common symptom of IIH in this prospective study of participants with mild visual loss and was often the initial symptom; the prominence of this finding is concordant with several prior reports. 3,8,9 Both providers and patients often perceive the headache of IIH as being directly linked to CSF pressure elevation, and they anticipate that lowering CSF pressure will improve headache control. Indeed, the ICHD-3b includes headache improvement or worsening with CSF pressure reduction or elevation, respectively, in the criteria for IIH-related headache.…”

Obesity and Headache: Part I – A Systematic Review of the Epidemiology of Obesity and Headache

“…These patients often present with enlarged blind spot, papilledema, visual field deficits, and occasionally 6th nerve palsies . Headache is reported by about 75‐94% of IIH patients and is often the first symptom reported . With withdrawal of CSF and lowered pressure, headache usually improves .…”

Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management

“…IIH causes significant morbidity, including permanent visual loss in up to 25% of cases2 with reports of 1–2% of new cases being registered blind per year3 and disabling headache in the majority 4. With peak presentation being between ages 20 and 40 years5; an overwhelming female predominance and a strong association with obesity5; IIH, is well known as a disorder that affects overweight women of reproductive age.…”