A Population-Based, Case-Control Evaluation of the Association Between Hormonal Contraceptives and Idiopathic Intracranial Hypertension

Kilgore, Khin P.; Lee, Michael S.; Leavitt, Jacqueline A.; Frank, Ryan D.; McClelland, Collin M.; Chen, John J.

doi:10.1016/j.ajo.2018.09.014

Cited by 27 publications

(25 citation statements)

References 36 publications

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“…the exposure to hormonal contraceptives was lower in IIH than in GP controls. This supports previous reports that use of contraceptives containing oestrogen is not a risk factor for IIH development (4,6,8) and is in line with the results from Kilgore et al (9). However, we cannot rule out that there might be an increased risk with certain types of hormonal contraceptives (11).…”

Section: Factors Associated With Iihsupporting

confidence: 93%

“…For some of these factors, the strength of the association has been questioned (4). There are few previous case-control studies available with a representative control population investigating risk factors associated with IIH, most including between 20-60 cases (5)(6)(7)(8)(9) aside from two studies investigating fluoroquinolones antibiotics (339 cases) (10) and hormonal contraceptives (3323 cases) (11). Otherwise knowledge on risk factors is based primarily on case reports or reviews (4,12).…”

Section: Introductionmentioning

confidence: 99%

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A national Swedish case-control study investigating incidence and factors associated with idiopathic intracranial hypertension

et al. 2021

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Objective To study the incidence of idiopathic intracranial hypertension in Sweden and to explore whether previously proposed risk factors are associated with idiopathic intracranial hypertension by investigating the odds of exposure one year prior to diagnosis in patients compared to controls. Methods Using Swedish health care registers and validated diagnostic algorithms, idiopathic intracranial hypertension patients diagnosed between 2000–2016 were compared with randomly selected matched controls, five from the general population and five with obesity. Results We identified 902 idiopathic intracranial hypertension patients and 4510 matched individuals in each control group. Mean incidence among inhabitants ≥18 years of age was 0.71 per 100,000; rising from 0.53 in 2000–2005 to 0.95 in 2012–2016. There were increased odds for idiopathic intracranial hypertension patients compared to general population for exposure to: kidney failure (odds ratio =13.2 (4.1–42.0)), arterial hypertension (odds ratio =17.5 (10.5–29.3)), systemic lupus erythematosus (odds ratio =13.8 (4.3–44.7)), tetracyclines, sulphonamides, lithium, and corticosteroids. In obese controls, odds ratios were also significantly increased for these exposures. Hormonal contraceptive use and exposure to pregnancy did not appear to be associated factors for idiopathic intracranial hypertension development. Conclusions The incidence of idiopathic intracranial hypertension in Sweden is lower relative to reports from other countries but is on the rise. This case-control study confirms several previously reported risk factors associated with idiopathic intracranial hypertension.

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Section: Factors Associated With Iihsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

A national Swedish case-control study investigating incidence and factors associated with idiopathic intracranial hypertension

et al. 2021

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“…10,14 Despite similar risk factors and age-group, female preponderance was found among IIH patients in the study of Bruce et al 15 Hormonal etiology could be a predisposing factor for IIH in the female during the fertility period. Previous studies had shown an association of OCP and IIH which was not found to be related in a recent study by Kilgore et al 16 Headache characteristics in IIH are nonspecific. Usually early symptoms are similar to tension-type headaches or migraine.…”

Section: Resultsmentioning

confidence: 76%

Clinical Manifestations, Neuroimaging Findings, and Treatment of Idiopathic Intracranial Hypertension in a Nepalese Tertiary Centre

et al. 2021

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Introduction: Idiopathic Intracranial Hypertension is characterized by headache, visual impairment, papilledema, and increased cerebrospinal fluid opening pressure. We aim to evaluate clinical manifestations, neuroimaging findings, and treatment of Idiopathic Intracranial Hypertension in a Nepalese tertiary center. Materials and Methods: We retrospectively included patients with the diagnosis of Idiopathic Intracranial Hypertension who were admitted to the Neurology department of Tribhuvan University Teaching Hospital from 2019 June to 2021 May and presented to the Neuro-ophthalmology outpatient clinic of the hospital for follow-up. Results: Out of 16 Idiopathic Intracranial Hypertension patients, 12(75%) patients had either headache or ocular pain. Reduced visual acuity and progressive visual loss were found in 44% of patients. Normal CSF opening pressure was found in 19%, 44% had CSF opening pressure at a range of 20-30 cm H20 and > 30 cm H20 in 37.5%. 15 Idiopathic Intracranial Hypertension patients (93.7%) were subtyped as Typical and 1 patient was diagnosed as Fulminant Idiopathic Intracranial Hypertension. Acetazolamide was used for treatment in 15 patients and 1 patient needed ventriculoperitoneal shunting. 56% Seven patients (44%) had some abnormal findings: partial empty sella (44%), and tortuous optic nerve (31%), flattened posterior eyeball (31%), and hypoplastic transverse sinus (19%). Conclusions: Idiopathic Intracranial Hypertension is an uncommon diagnosis but should be suspected in patients with chronic headaches with visual impairment. In low-resource settings, proper history along with neurological and ophthalmological examinations can even detect the early features and timely referral can save the vision and disability of Idiopathic Intracranial Hypertension patients.

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“…While a previous case series reported OCP use in 24% of IIH patients, 27 a case-control study comparing patients with IIH to age, sex and body mass index-matched patients did not find a significant association between OCP use and IIH. 42 Headache was the most commonly reported symptom. Consistent with prior literature, we have identified the co-occurrence of IIH and either pre-existing or subsequent headache diagnoses, in particular, migraine.…”

Section: Discussionmentioning

confidence: 99%

Incidence of idiopathic intracranial hypertension in Southern Tasmania, Australia

Krishnadas

Taylor

2021

BMJ Neurol Open

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IntroductionAnecdotally, the incidence of idiopathic intracranial hypertension (IIH) is increasing, linked to an increase in the obesity rate in Australian society. However, formal incidence and prevalence studies are rare. We therefore sought to determine the incidence and clinical features of IIH in Southern Tasmania, Australia.MethodNeurology discharge summaries and lumbar puncture referrals from the single tertiary referral centre in this region were screened for an IIH diagnosis. All regional neurologists were surveyed to capture patients diagnosed through private neurology clinics. A retrospective review of medical records was conducted to confirm the diagnosis and determine whether patients met the Modified Dandy Criteria (MDC). Patients were included if they were above the age of 18 years and received a new diagnosis of IIH between June 2016 and June 2018. Population statistics were obtained from the Australian Bureau of Statistics.ResultsIIH incidence was 5.4/100 000. All patients were females, aged between 18 and 45 years. Headache was the most commonly reported symptom, with high rates of pre-existing or concurrent migraine diagnoses. Weight loss and commencement of oral acetazolamide were the most common treatment approaches. Four patients were medically refractory and required surgical intervention.ConclusionThe incidence of IIH in Southern Tasmania is comparable with the incidence reported in subgroups of females of childbearing age in recent prior studies. The demographic, diagnostic and therapeutic data presented can inform future local health service provision and serve as a baseline for ongoing assessment of change in incidence and treatment of IIH at a community level.

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A Population-Based, Case-Control Evaluation of the Association Between Hormonal Contraceptives and Idiopathic Intracranial Hypertension

Cited by 27 publications

References 36 publications

A national Swedish case-control study investigating incidence and factors associated with idiopathic intracranial hypertension

A national Swedish case-control study investigating incidence and factors associated with idiopathic intracranial hypertension

Clinical Manifestations, Neuroimaging Findings, and Treatment of Idiopathic Intracranial Hypertension in a Nepalese Tertiary Centre

Incidence of idiopathic intracranial hypertension in Southern Tasmania, Australia

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