Objective: To identify the pressure-related features of isolated cerebrospinal fluid hypertension (ICH) in order to differentiate headache sufferers with ICH from those with primary headache disorder.Methods: In this prospective study, patients with refractory chronic headaches and suspected of having cerebrospinal fluid-pressure elevation without papilledema or sixth nerve palsy, together with controls, underwent 1-h lumbar cerebrospinal fluid pressure monitoring via a spinal puncture needle.Results: We recruited 148 consecutive headache patients and 16 controls. Lumbar cerebrospinal fluid pressure monitoring showed high pressure and abnormal pressure pulsations in 93 (63 %) patients with headache: 37 of these patients with the most abnormal pressure parameters (opening pressure above 250 mm H2O, mean pressure 301 mm H2O, mean peak pressure 398 mm H2O, and severe abnormal pressure pulsations) had the most severe headaches and associated symptoms (nocturnal headache, postural headache, transient visual obscuration); 56 patients with the less abnormal pressure parameters (opening pressure between 200 and 250 mm H2O, mean pressure 228 mm H2O, mean peak pressure 316 mm H2O, and abnormal pressure pulsations) had less severe headaches and associated symptoms.Conclusions: Nocturnal and postural headache, and abnormal pressure pulsations are the more common pressure-related features of ICH in patients with chronic headache. Abnormal pressure pulsations may be considered a marker of ICH in chronic headache.

Severe CA is associated with decreased response to treatment with OTES in patients with CM and CTTH.

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Objective To evaluate whether increased cerebrospinal fluid ( CSF ) pressure causes alteration of periventricular white matter ( WM ) microstructure in patients with idiopathic intracranial hypertension ( IIH ). Methods In a prospective study, patients with refractory chronic headache with and without IIH performed a neuroimaging study including 3T MRI , 3D Phase Contrast MR venography, and diffusion tensor imaging ( DTI ) of the brain. Whole‐brain voxel‐wise comparisons of DTI abnormalities of WM were performed using tract‐based spatial statistics. A correlation analysis between DTI indices and CSF opening pressure, highest peak, and mean pressure was also performed in patients with IIH . Results We enrolled 62 consecutive patients with refractory chronic headaches. Thirty‐five patients with IIH , and 27 patients without increased intracranial pressure. DTI analysis revealed no fractional anisotropy changes, but decreased mean, axial, and radial diffusivity in body ( IIH MD = 0.80 ± 0.04, non‐ IIH MD = 0.84 ± 0.4, IIH AD = 1.67 ± 0.07, non‐ IIH AD = 1.74 ± 0.05, IIH RD = 0.38 ± 0.04, non‐ IIH RD = 0.42 ± 0.05 [mm 2 /sec × 10 −3 ]) of corpus callosum, and in right superior corona radiata ( IIH MD = 0.75 ± 0.04, non‐ IIH MD = 0.79 ± 0.05, IIH AD = 1.19 ± 0.07, non‐ IIH AD = 1.28 ± 0.09, IIH RD = 0.59 ± 0.03, non‐ IIH RD = 0.53 ± 0.03 [mm 2 /sec × 10 −3 ]) of 35 patients with IIH compared with 27 patients without increased intracranial pressure. DTI indices were negatively correlated with high CSF pressures ( P < 0.05). After medical treatment, eight patients showed incremented MD in anterior corona radiata left and right and superior corona radiata right. Conclusions There is significant DTI alteration in perivent...

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