Coexistence of migraine and idiopathic intracranial hypertension without papilledema

Abstract

Eighty-five patients with refractory transformed migraine type of chronic daily headache (CDH) had spinal tap as a part of diagnostic work-up. Twelve had increased intracranial pressure without papilledema, transient visual obscurations, or visual field defects. The headache profile of these 12 patients was not different from that of transformed migraine type of CDH. Acute headache exacerbations responded to specific antimigraine agents such as ergotamine, dihydroergotamine (DHE), and sumatriptan, whereas prophylactic antimigraine medications were only partially helpful. Addition of agents such as acetazolamide and furosemide, after the diagnosis of increased intracranial pressure, resulted in better control of symptoms. These observations suggest a link between migraine and idiopathic intracranial hypertension that needs further research. In refractory CDH with migrainous features, a spinal tap to exclude coexistent idiopathic intracranial hypertension without papilledema may be indicated.

Migraine headache in patients with idiopathic intracranial hypertension

“…In study by Kathleen et al, that assessed the clinical characteristics of IIH patients with and without papilledema, shows that the prevalence of migraine headache in patients with- out papilledema was 65% and in patients with papilledema was 45%. 10 Curiously there is relation between migraine and intracranial hypertension that is very complex and need more study. Mathew et al assessed the prevalence of intracranial pressure in patients with chronic unresponsive migraine headache, in this study 44 patients with chronic migraine headache and stenosis in sinus vein in mri venography were assessed that 86.4% of this patients have raised intracranial hypertension (csf pressure >200 mmH2O).…”

“…The 77% of this patient, experience decreased headache with treatment of ICP raising. 10 In another study by Ramadan that assessed the IIH in the patients with chronic daily headache, 12 patients have intracranial hypertension that do not have any evidence of papilledema, visual obscuration and decreased visual acuity and the treatment with acetazolamide reduce their chronic headache. 11 However, it seems that in any patients with chronic migraine headache that is refractory and do not respond to usual prophylactic migraine headache, it is essential that done spinal tap for rule out of idiopathic intracranial hypertension without papilledema.…”

“…[3][4][5] Idiopathic intracranial hypertension (IIH) presents with headache, diplopia due to cranial nerve palsy, visual obscuration, tinnitus and papilledema with normal cerebrospinal fluid (CSF) analysis and neuroimaging. 6,7 Many of this patient after treatment complain of headache without any abnormality in optic disc and CSF pressure. In present study, we assessed the prevalence of migraine in patients with IIH as common cause of headache.…”

Continuous 24-Hour Intraocular Pressure Pattern Monitoring in Medically Treated Normal Tension Glaucoma

“…Papilloedema is present in the majority of patients with IIH and usually occurs bilaterally [11], although unilateral occurrences were reported in 10% of cases [12,13]. Recent evidence revealed that papilloedema is caused interruptions in the optic nerve (ON) metabolism as a result of the high intracranial pressure transmitted to the subarachnoid space surrounded the ON, leading to edema, ischemia, and eventual visual impairment or loss.14 Choroidal folds arise from globe compression from the distended optic nerve sheath leading to globe distortion and acquired hyperopic shift [15][16][17][18][19][20][21].…”

New Daily Persistent Headache

“…It is recognised that intractable chronic migraine can be triggered by persistently raised intracranial pressure. 15 These patients typically give a history of generalised headache that is present on waking, and gets better as the day goes on. It is generally worse with recumbency.…”