Idiopathic Intracranial Hypertension With and Without Papilloedema in a Consecutive Series of Patients With Chronic Migraine (original) (raw)
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Intracranial pressure directly predicts headache morbidity in idiopathic intracranial hypertension
The Journal of Headache and Pain
Objective Headache is the predominant disabler in idiopathic intracranial hypertension (IIH). The aim was to characterise headache and investigate the association with intracranial pressure. Methods IIH:WT was a randomised controlled parallel group multicentre trial in the United Kingdom investigating weight management methods in IIH. Participants with active IIH (evidenced by papilloedema) and a body mass index (BMI) ≥35 kg/m2 were recruited. At baseline, 12 months and 24 months headache characteristics and quality of life outcome measures were collected and lumbar puncture measurements were performed. Results Sixty-six women with active IIH were included with a mean age of 32.0 years (SD ± 7.8), and mean body mass index of 43.9 ± 7.0 kg/m2. The headache phenotype was migraine-like in 90%. Headache severity correlated with ICP at baseline (r = 0.285; p = 0.024); change in headache severity and monthly headache days correlated with change in ICP at 12 months (r = 0.454, p = 0.001 an...
Is idiopathic intracranial hypertension without papilledema a risk factor for migraine progression?
Neurological Sciences, 2010
The association of chronic migraine (CM) with an idiopathic intracranial hypertension without papilledema (IIHWOP), although much more prevalent than expected in clinical series of CM sufferers, is not included among the risk factors for migraine progression. We discuss the available evidence supporting the existence of a pathogenetic link between CM and idiopathic intracranial hypertensive disorders and suggest a causative role for IIHWOP in migraine progression. Keywords Chronic migraine Á Idiopathic intracranial hypertension Á Idiopathic intracranial hypertension without papilledema Á Medication overuse headache Á Central venous stenosis Á Review
Iranian Journal of Neurology, 2019
Background: Idiopathic intracranial hypertension (IIH) encompasses patients with elevated intracranial pressure (ICP). Generally, it is difficult to make a differential diagnosis between IIH and co-existing migraine headaches. Thus, this article intends to estimate the prevalence of migraine in patients with IIH and explain the occurrence of new-onset migraine after the diagnosis of IIH. Methods: The case group included 108 patients with IIH referred to the neurology wards of three university hospitals. A random sample of controls (n = 103) were recruited from patients hospitalized in the surgery and orthopedics ward. A checklist for migraine diagnosis was filled out. Cerebrospinal fluid (CSF) pressure and presence or absence of papilloedema (PE) in the patients and any necessary data were also recorded from the inpatient medical documents. All statistical analyses were done by SPSS software. Results: There were 70 (64.80%) and 22 (21.40%) migraineurs in the case and control groups...
Research Square (Research Square), 2022
Background: Migrainous headache is common in idiopathic intracranial hypertension (IIH). The aim of this study was to assess its prognostic impact. Methods: We investigated patients with IIH from the Vienna-IIH-database and differentiated migraine (IIH-MIG) from non-migrainous and absent headache (IIH-noMIG). Using multivariate models, we analyzed the impact of IIH-MIG on headache and visual outcomes 12 months after diagnosis. Results: Among 97 patients (88.7% female, mean age 32.9±11.1 years, median BMI 32.0, median CSF opening pressure 31cmH2O), 46.4% were assigned to IIH-MIG and 53.6% to IIH-noMIG (11.3% tensiontype, 25.8% unclassi able, 16.5% no headache). At baseline, IIH-MIG differed from IIH-noMIG with respect to headache frequency (22 vs. 15 days/month, p=0.003) and severity (6.5/10 vs. 4.5/10; p<0.001). At follow-up, the rates for improvement and freedom of headache were lower in IIH-MIG than in IIH-noMIG for all patients (66.7% vs. 88.5%, p=0.009; 11.1% vs. 42.3%, p=0.006) and for those with resolution of papilledema (n=60; 62.1% vs. 93.6%, p=0.003; 17.2% vs. 61.3%, p<0.001). In contrast, visual worsening was signi cantly less common in IIH-MIG (8.9% vs. 25.0%, p=0.037). Adjusting for covariates, IIH-MIG was independently associated with a signi cantly lower likelihood of headache improvement (odds ratio [OR] 0.57, p<0.001) and freedom of headache (OR 0.28, p<0.001), but also a lower risk for visual worsening (OR 0.39, p<0.001). Conclusions: In IIH, migrainous headache is associated with unfavorable outcomes for headache, even when papilledema has resolved, and possibly favorable visual outcome.
European Headache Federation guideline on idiopathic intracranial hypertension
The Journal of Headache and Pain, 2018
Background: Idiopathic Intracranial Hypertension (IIH) is characterized by an elevation of intracranial pressure (ICP no identifiable cause. The aetiology remains largely unknown, however observations made in a number of recent clinical studies are increasing the understanding of the disease and now provide the basis for evidence-based treatment strategies. Methods: The Embase, CDSR, CENTRAL, DARE and MEDLINE databases were searched up to 1st June 2018. We analyzed randomized controlled trials and systematic reviews that investigate IIH. Results: Diagnostic uncertainty, headache morbidity and visual loss are among the highest concerns of clinicians and patients in this disease area. Research in this field is infrequent due to the rarity of the disease and the lack of understanding of the underlying pathology. Conclusions: This European Headache Federation consensus paper provides evidence-based recommendations and practical advice on the investigation and management of IIH.
Advances in the understanding of headache in idiopathic intracranial hypertension
Current Opinion in Neurology, 2018
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 re-examining 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 ther...
Headache: The Journal of Head and Face Pain, 2021
ObjectiveHeadache 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.BackgroundDisability 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.MethodsA detailed search of the scientific literature and narrative review was performed.ResultsHeadache 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 ...
Headache, 2017
To characterize the phenotype, headache-related disability, medical co-morbidities, use of symptomatic headache medications, and headache response to study interventions in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). Patients with untreated IIH and mild vision loss enrolled in the IIHTT and randomized to acetazolamide (ACZ) and weight loss or placebo (PLB) and weight loss had prospective assessment of headache disability using the Headache Impact Test-6 (HIT-6) questionnaire. Subjects with headache at the baseline visit were assigned a headache phenotype using the International Classification for Headache Disorders version 3 beta (ICHD-3b). Medication overuse was determined using the participants' reported medication use for the preceding month and ICHD-3b thresholds for diagnosing medication overuse headache. We investigated relationships between headache disability and various other clinical characteristics at baseline and at 6 months. Headache was presen...
Noninvasive intracranial pressure monitoring in women with migraine
Scientific Reports, 2022
This cross-sectional study aimed to compare the waveform morphology through noninvasive intracranial pressure (ICP-NI) measurement between patients with migraine and controls, and to analyze the association with clinical variables. Twenty-nine women with migraine, age 32.4 (11.2) years and headache frequency of 12.6 (7.5) days per month and twenty-nine women without headache, age 32.1 (9.0) years, were evaluated. Pain intensity, migraine disability, allodynia, pain catastrophizing, central sensitization and depression were evaluated. The ICP-NI monitoring was performed by a valid method consisting of an extracranial deformation sensor positioned in the patients' scalp, which allowed registration of intracranial pressure waveforms. Heart rate and blood pressure measurements were simultaneously recorded during 20 min in the supine position. The analyzed parameter was the P2/P1 ratio based on mean pulse per minute which P1 represents the percussion wave related to the arterial blood pression maximum and P2 the tidal wave, middle point between the P1 maximum and the dicrotic notch. There was no between-groups difference in the P2/ P1 ratio (mean difference: 0.04, IC95%:-0.07 to 0.16, p = 0.352, F (1,1) = 0.881) adjusted by body mass index covariable. The Multiple Linear Regression showed non-statistical significance [F (5,44) = 1.104; p = 0.372; R 2 = 0.11)] between the P2/P1 ratio and body mass index, presence of migraine, central sensitization, pain catastrophizing and depression. We found no correlation (p > 0.05) between P2/P1 ratio and migraine frequency, migraine onset, pain intensity, pain intensity at day of examination, disability, allodynia. Migraine patients did not present alterations in the waveform morphology through ICP-NI compared to women without headache and no association with clinical variables was found. Abbreviations ICP-NI Noninvasive intracranial pressure CSF Cerebrospinal fluid ICP Intracranial pressure MIDAS Migraine Disability Assessment IL-1ra IL-1 receptor antagonist MCP-1 Monocyte chemoattractant protein-1 A central nervous system sensitization has been associated with the experience of persistent pain and symptoms such as hyperalgesia, allodynia and hypersensitivity, due to sensory processing changes, neuroplasticity and neuroinflammation 1,2. Studies have also suggested a possible association between these symptoms with the increased intracranial pressure (ICP) in conditions such as chronic fatigue syndrome, fibromyalgia, unexplained
Idiopathic Intracranial Hypertension Without Papilledema (IIHWOP) in Chronic Refractory Headache
Frontiers in Neurology, 2018
Background: To determine the prevalence of Idiopathic intracranial hypertension without papilledema (IIHWOP) testing revised diagnostic criteria by Friedman in refractory chronic headache (CH) patients. Methods: This is a prospective observational study. Each patient underwent ophthalmologic evaluation and Optical Coherence Tomography; brain magnetic resonance venography (MRV) and a lumbar puncture (LP) with opening pressure (OP) measurement. CSF withdrawal was performed in patients with CSF OP > 200 mmH20. IIHWOP was defined according Friedman's diagnostic criteria. Effect of CSF withdrawal was evaluated clinically in a 6-month follow-up and with a MRV study at 1 month. Results: Forty-five consecutive patients were enrolled. Five were excluded due to protocol violations. Analyses were conducted in 40 patients (32 F, 8 M; mean age 49.4 ± 10.8). None had papilledema. Nine patients (22.5%) had OP greater than 200 mmH2O, two of them above 250 mmH2O. Two (5%) had neuroimaging findings suggestive of elevated intracranial pressure. One of them (2.5%) met the newly proposed diagnostic criteria by Friedman for IIHWOP. After CSF withdrawal seven (77.8%) of the nine patients improved. No changes in neuroimaging findings were found. Conclusions: We found a low prevalence (2.5%) of IIHWOP in refractory CH patients according to current diagnostic criteria. In agreement with Friedman's criteria, our results confirm that a diagnosis of IIHWOP should be based on CSF OP and the combination of neuroradiological findings. However, where to set the CSF OP upper limit in IIHWOP needs further field testing. Although IIHWOP is a rare clinical condition, it should be considered and treated in refractory CH patients.