From the Guidelines
Idiopathic intracranial hypertension (IIH) primarily presents with headaches and visual disturbances, and management should focus on weight management and headache control, as advised by experienced clinicians within a multidisciplinary team setting 1.
Symptoms of IIH
The symptoms of IIH include:
- Headaches that are typically daily, worse in the morning or when lying down, and may be accompanied by nausea and vomiting
- Visual symptoms such as transient visual obscurations (brief dimming or blacking out of vision), double vision, and peripheral vision loss
- Pulsatile tinnitus (whooshing sounds in the ears synchronized with heartbeat), shoulder or neck pain, and back pain
- Photophobia, phonophobia, dizziness, and cognitive difficulties such as memory problems or brain fog
Diagnosis and Management
IIH occurs most commonly in women of childbearing age with obesity, though it can affect anyone 1. The condition results from increased cerebrospinal fluid pressure without an identifiable cause such as a tumor or infection.
Key Considerations
- Early diagnosis and treatment are crucial to prevent permanent vision loss, which can occur if the condition remains untreated
- Management of headaches in IIH should be the same as typical IIH, and surgical management to control elevated intracranial pressures should not routinely be considered unless advised by experienced clinicians within a multidisciplinary team setting 1
- Shunted patients with IIH may have significant headache morbidity, and shunt failures and overdrainage should always be considered, with management guided by an experienced clinician who routinely manages headache 1
From the Research
Idiopathic Intracranial Hypertension Symptoms
The symptoms of idiopathic intracranial hypertension (IIH) include:
- New onset headache, which is frequently non-specific 2
- Papilloedema 2
- Visual disturbances, such as visual obscuration 3
- Sixth nerve palsy 2
- Increased intracranial pressure without a known cause 4, 2
Diagnosis and Treatment
Diagnosis of IIH includes:
- Brain imaging with venography to exclude structural causes and venous sinus thrombosis 2
- Lumbar puncture to reveal pressure greater than 250 mmCSF with normal constituents 2 Treatment options for IIH include:
- Weight loss, which can help reduce intracranial pressure 4, 5, 3
- Medical therapies, such as acetazolamide and topiramate, which can help reduce cerebrospinal fluid pressure and alleviate symptoms 4, 5, 3, 6
- Surgical interventions, which may be necessary for patients with rapid visual decline or severe symptoms 4, 2
Comparison of Treatment Options
Studies have compared the efficacy of topiramate and acetazolamide in the treatment of IIH, with results showing that both medications can be effective in improving visual metrics and decreasing cerebrospinal fluid pressure 5, 3. Topiramate has the added benefit of promoting weight loss, which can help reduce intracranial pressure 5, 3. Acetazolamide, on the other hand, is a conventional treatment that can help lower CSF pressure and alleviate visual changes 3, 6. A combination treatment of topiramate and acetazolamide may be recommended for better results 3.