Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May;63(5):601-610.
doi: 10.1111/head.14478. Epub 2023 Feb 8.

Idiopathic intracranial hypertension presenting with migraine phenotype is associated with unfavorable headache outcomes

Gabriel Bsteh  1   2 , Stefan Macher  1   2 , Nik Krajnc  1   2 , Philip Pruckner  1   2 , Wolfgang Marik  3 , Christoph Mitsch  4 , Klaus Novak  2   5 , Berthold Pemp  4 , Christian Wöber  1   5
Affiliations

Idiopathic intracranial hypertension presenting with migraine phenotype is associated with unfavorable headache outcomes

Gabriel Bsteh et al. Headache. 2023 May.

Abstract

Objective: To assess the prognostic impact of migraine headache in idiopathic intracranial hypertension (IIH).

Background: Migraine headache is common in IIH, but it is unclear whether it has prognostic relevance.

Methods: We investigated patients with IIH from the Vienna-IIH-database and differentiated migraine (IIH-MIG) from non-migraine headache (IIH-nonMIG) and without headache (IIH-noHA). Using multivariable models, we analyzed the impact of IIH-MIG on headache and visual outcomes 12 months after diagnosis.

Results: Among 97 patients (89% female, mean [SD] age 32.9 [11.1] years, median body mass index 32.0 kg/m2 , median cerebrospinal fluid opening pressure 310 mm), 46% were assigned to IIH-MIG, 37% to IIH-nonMIG (11% tension-type, 26% unclassifiable), and 17% to IIH-noHA. Overall, headache improvement was achieved in 77% and freedom of headache in 28%. The IIH-MIG group showed significantly lower rates for headache improvement (67% vs. 89% in IIH-nonMIG, p = 0.019) and freedom of headache (11% vs. 33% in IIH-nonMIG and 63% in IIH-noHA, p = 0.015). These differences persisted when only analyzing patients with resolved papilledema at follow-up. In contrast, visual worsening was significantly less common in IIH-MIG (9% vs. 28% in IIH-nonMIG and 31% in IIH-noHA, p = 0.045). In multivariable models, IIH-MIG was associated with a significantly lower likelihood of achieving headache improvement (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.40-0.78, p < 0.001) and freedom of headache (OR 0.29, 95% CI 0.12-0.46, p < 0.001), but also a lower risk for visual worsening (OR 0.26, 95% CI 0.04-0.82, p < 0.001).

Conclusions: In IIH, migraine headache is associated with unfavorable outcomes for headache, even when papilledema has resolved, and possibly favorable visual outcome.

Keywords: headache; idiopathic intracranial hypertension; migraine; outcome; visual.

PubMed Disclaimer

Comment in

References

REFERENCES

    1. Radhakrishnan K, Ahlskog JE, Cross SA, et al. Idiopathic intracranial hypertension (Pseudotumor cerebri): descriptive epidemiology in Rochester, Minn, 1976 to 1990. Arch Neurol. 1993;50:78-80.
    1. Kilgore KP, Lee MS, Leavitt JA, et al. Re-evaluating the incidence of idiopathic intracranial hypertension in an era of increasing obesity. Ophthalmology. 2017;124:697-700.
    1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38:1-211.
    1. Mollan SP, Hoffmann J, Sinclair AJ. Advances in the understanding of headache in idiopathic intracranial hypertension. Curr Opin Neurol. 2019;32:92-98.
    1. Friedman DI. Headaches in idiopathic intracranial hypertension. J Neuroophthalmol. 2019;39:82-93.