New horizons for idiopathic intracranial hypertension: advances and challenges

Abstract

Introduction Idiopathic intracranial hypertension (IIH) is becoming a recognized condition due to the increasing incidence linked to a global obesity epidemic. Sources of data All English papers on PubMed, Cochrane and Scholar between inception until 1 March 2020 were considered. Areas of agreement Studies suggest central adiposity has a pathogenic role. Recent weight gain is a risk factor and weight loss has a key role in management. Areas of controversy Interpretation of abnormal lumbar puncture opening pressure is debated. There is an increasing recognition of obesity stigma and how this should be approached. Growing points Further evidence is required for the choice of surgical intervention for fulminant IIH. Education regarding IIH should be evidence based. Areas timely for developing research Novel research of the pathology of IIH is influencing development of therapies such as glucagon-like peptide-1 receptor agonists and targeting unique androgen signatures. The newly discovered cardiovascular risk requires further attention.

Headache attributed to idiopathic intracranial hypertension and persistent post‐idiopathic intracranial hypertension headache: A narrative review

“…The preponderance of IIH is characterized by symptoms of raised ICP, which include headache, visual disturbances, pulsatile tinnitus, and papilledema. 1,2 The historical features of raised ICP, such as a waking nonspecific headache that occurs in the minority, underline the importance of fundoscopy in all-new-onset headache and those have an exacerbation of their headache history. 24 In adults, headache features often resemble those with primary headache disorders.…”

“…Idiopathic intracranial hypertension (IIH) is a disabling secondary headache disorder characterized by raised intracranial pressure (ICP) and papilledema with the potential risk of permanent visual loss. 1,2 There is an established association with obesity 3,4 and increasing prevalence [5][6][7] currently estimated at 68 per 100,000 females. 6 Although there has been progress in diagnostic algorithims, [8][9][10][11] there are little data to help guide treatment decisions for headache.…”

The effect of GLP-1RA exenatide on Idiopathic Intracranial Hypertension: Randomised Clinical Trial

“…Recent weight gain is the major risk factor for development of the condition and its occurrence is most commonly observed in women of reproductive age with obesity. [10,11] Weight loss is disease modifying and if maintained can induce remission. [12,13] As the incidence of IIH is rising [14][15][16] in line with global obesity trends, [17] targeted treatments are an unmet clinical need.…”

The Health Economic Evaluation of Bariatric Surgery Versus a Community Weight Management Intervention Analysis from the Idiopathic Intracranial Hypertension Weight Trial (IIH:WT)

“…Body weight is the main modifiable risk factor in IIH [10,11], specifically central adiposity [12]. Understanding this role of weight management in the disease was set as a high research priority by physicians, carers, and patients [13].…”