Prevalence of new-onset migraine in patients with idiopathic intracranial hypertension in comparison to the general population

Abstract

Background: Idiopathic intracranial hypertension (IIH) encompasses patients with elevated intracranial pressure (ICP). Generally, it is difficult to make a differential diagnosis between IIH and co-existing migraine headaches. Thus, this article intends to estimate the prevalence of migraine in patients with IIH and explain the occurrence of new-onset migraine after the diagnosis of IIH. 
 Methods: The case group included 108 patients with IIH referred to the neurology wards of three university hospitals. A random sample of controls (n = 103) were recruited from patients hospitalized in the surgery and orthopedics ward. A checklist for migraine diagnosis was filled out. Cerebrospinal fluid (CSF) pressure and presence or absence of papilloedema (PE) in the patients and any necessary data were also recorded from the inpatient medical documents. All statistical analyses were done by SPSS software.
 Results: There were 70 (64.80%) and 22 (21.40%) migraineurs in the case and control groups, respectively, and the difference was found to be 
 significant (P < 0.001). In 26 (37.14%) migraine cases in the IIH group, the disorder was diagnosed after developing IIH. Also, there was a past medical history of having migraine in 44 (62.85%) migraineurs. In the fully adjusted regression models, the odds of being affected by migraine in patients with IIH was 6.17 times greater than the controls [odds ratio (OR) = 7.15, 95% confidence interval (CI) = 3.56-14.36, P < 0.010]. The patients’ mean CSF opening pressure was 32.10 ± 1.03 cmH2O and 93 (81.60%) subjects were found to have PE.
 Conclusion: It was demonstrated that subjects with IIH might have about a 6-time higher likelihood of developing migraine headache than the general population. These considerations can help prevent misdiagnosis of migraine headache as the recurrence of IIH or uncontrolled IIH and subsequent inappropriate management.

Idiopathic Intracranial Hypertension and Multiple Sclerosis Overlap

“…Headaches are a common presenting complaint in the primary care setting [11][12]. IIH and MS can often present with overlapping symptoms such as headaches [7,[9][10][11][12]. A thorough fundoscopic exam can help differentiate between IIH and other causes of headache [7,10,[13][14].…”

“…IIH and MS can often present with overlapping symptoms such as headaches [7,[9][10][11][12]. A thorough fundoscopic exam can help differentiate between IIH and other causes of headache [7,10,[13][14]. Further workup is important when evaluating IIH as demyelinating diseases such as MS and neuromyelitis optica (NMO) can often overlap [12].…”

“…The increasing CSF leads to increased intracranial pressure, according to the Monro-Kellie hypothesis, which damages vulnerable structures, particularly the optic nerve fiber layer [1][2][3][4][5][6]. The first-line treatment is acetazolamide along with weight loss or dural venous sinus stenting [1][2]5,[7][8][9][10]. In select patients, the workup for intracranial hypertension may reveal an underlying demyelinating disease process such as multiple sclerosis (MS).…”

The trend of incidence and burden of neurological disease in Iran between 1990 and 2017: Based on global burden of disease estimations

“…16 - 19 The reasons should be investigated; because it may be partly due to the aging population, the improvement of therapeutic facilities and more patient survival, or the increased exposure to hazardous exposures associated with neurological diseases. 20 , 21…”

Are the ICHD-3 criteria for headache attributed to idiopathic intracranial hypertension valid? Headache phenotyping and field-testing in newly diagnosed idiopathic intracranial hypertension

“…Although several studies characterize headache in IIH, few describe headaches that have clearly evolved in temporal relation to the diagnosis. Pre-existing headache in IIH is reported in 45-63% (10)(11)(12) and in the IIH Treatment Trial (IIHTT), headache was the initial presenting symptom in <40% but existed in 84% of patients at time of IIH diagnosis (13). This reflects a significant burden of headache whose relation to IIH pathology is uncertain.…”