Idiopathic Intracranial Hypertension With and Without Papilloedema in a Consecutive Series of Patients With Chronic Migraine

Abstract

Chronic migraine (CM) has been associated with idiopathic intracranial hypertension without papilloedema (IIHWOP), a significant percentage of these cases occurring in obese patients with intractable headache. A prospective study from February 2005 to June 2006 was made of 62 CM patients who fulfilled International Headache Society diagnostic criteria and had cerebral magnetic resonance venography (MRV) and lumbar puncture (LP) done. Two patients were excluded, six (10%) with elevated cerebrospinal fluid (CSF) open pressure (OP), five with body mass index (BMI) > 25. None of the patients had papilloedema or abnormal MRV. BMI and CSF OP were significantly correlated (r = 0.476, P < 0.001, Pearson's correlation test). Obesity (defined as BMI > 30) was a predictor of increase in intracranial pressure (defined as OP > 200 mmH(2)O) (f = 17.26, 95% confidence interval 6.0, 8.6; P < 0.001). From our study we strongly recommend that not only intractable CM patients with high BMI, but also first diagnosed patients with BMI > 30 should be systematically evaluated by a LP to rule out IIHWOP.

OCT for optic disc evaluation in idiopathic intracranial hypertension

“…In a study of 85 patients with refractory migraine, Mathew et al found 12 cases with IIHWOP [24]. Subsequently, Vieira et al identified six IIHWOP patients in 62 consecutive patients with chronic migraine [21], and Torbey et al demonstrated that some individuals with unspecified chronic daily headache, no papilledema and an opening pressure within normal limits can experience pathologic elevated intracranial pressure waveforms during sleep, and benefit by shunt surgery [22].…”

“…Nonetheless, subtle or early changes of the optic disc morphology may be missed. Supplemental stereo fundus photography and fluorescence angiography improve the detection rate, but papilledema is still absent in a minority of IIH patients [20][21][22][23][24].…”

Chronic Daily Headache in Children and Adolescents: A Multi-Faceted Syndrome

“…32 Chronic daily headache, CM in most reports, may associate with idiopathic intracranial hypertension (IIH; code 7.1.1) without papilledema. [81][82][83][84][85] Idiopathic intracranial hypertension may or may not be the sole cause of CDH in these cases. Chiari malformation type I (code 7.7) may cause CDH.…”

“…32 The possibility of IIH without papilledema must be considered under the following circumstances: (i) Intractable CDH, (ii) tinnitus or noise in the head as a symptom (important to seek this information), particularly in the presence of obesity, although subjects may be of normal weight. 32,[81][82][83][84][85] A detailed ophthalmologic examination, not only testing of visual acuity, examining fundii and assessing for venous pulsations but also blind spot charting, visual field assessment and contrast sensitivity, must be done in all those suspected of having IIH.…”

An update on the pathophysiology of idiopathic intracranial hypertension alias pseudotumor cerebri

“…Moreover, our study supported the fact that patients with IIH often relapse or continue experiencing headaches, despite the apparent normalization of their ICP. [11] Infrequently, IIH may present in the absence of papilledema [12][13][14] and the patients may experience a headache profile similar to chronic daily headache with migrainous features, responding to spesific antimigraine agents as well. [15] In a recent study, these patients without papilledema had lower opening pressure when compared with those with papilledema and visual acuities were similar between two groups.…”