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. 2025 Jan;1(1):31-39.
doi: 10.71079/aside.im.0000012282413. Epub 2024 Dec 28.

Epidemiological Patterns, Treatment Response, and Metabolic Correlations of Idiopathic Intracranial Hypertension: A United States-Based Study From 1990 to 2024

Ahmed Y Azzam  1   2   3 , Mahmoud Nassar  4   5 , Mahmoud M Morsy  6   7 , Adham A Mohamed  8 , Jin Wu  9 , Muhammed Amir Essibayi  1   10 , David J Altschul  1   10
Affiliations

Epidemiological Patterns, Treatment Response, and Metabolic Correlations of Idiopathic Intracranial Hypertension: A United States-Based Study From 1990 to 2024

Ahmed Y Azzam et al. ASIDE Intern Med. 2025 Jan.

Abstract

Introduction: Idiopathic Intracranial Hypertension (IIH) presents an increasing health burden with changing demographic patterns. We studied nationwide trends in IIH epidemiology, treatment patterns, and associated outcomes using a large-scale database analysis within the United States (US).

Methods: We performed a retrospective analysis using the TriNetX US Collaborative Network database (1990-2024). We investigated demographic characteristics, time-based trends, geographic distribution, treatment pathway patterns, comorbidity profiles, and associated risks with IIH. We used multivariate regression, Cox proportional hazards modeling, and standardized morbidity ratios to assess various outcomes and associations.

Results: Among 51,526 patients, we found a significant increase in adult IIH incidence from 16.0 per 100,000 in 1990-1999 to 127.0 per 100,000 in 2020-2024 (adjusted RR: 6.94, 95% CI: 6.71-7.17). Female predominance increased over time (female-to-male ratio: 3.29, 95% CI: 3.18-3.40). Southern regions showed the highest prevalence (43.0%, n=21,417). During the 2020-2024 period, initial medical management success rates varied between acetazolamide (42.3%) and topiramate (28.7%). Advanced interventional procedures showed 82.5% success rates in refractory cases during the same timeframe. Cox modeling for the entire study period (1990-2024) revealed significant associations between IIH and metabolic syndrome (HR: 2.14, 95% CI: 1.89-2.39) and cardiovascular complications (HR: 1.76, 95% CI: 1.58-1.94), independent of Body Mass Index.

Conclusions: Our findings highlight IIH as a systemic disorder with significant metabolic implications beyond its neurological manifestations. The marked regional disparities and rising incidence rates, especially among adults, suggest the need for targeted healthcare strategies. Early intervention success strongly predicts favorable outcomes, supporting prompt diagnosis and treatment initiation. These results advocate for an integrated approach combining traditional IIH management with broad metabolic screening care.

Keywords: Benign Intracranial Hypertesion; Epidemiology; Headache; Idiopathic Intracranial Hypertension; Intracranial Pressure; Metabolic Diseases; Papilledema; Pesudotumor Cerebri; TriNetX; United States.

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Figures

Figure 1:
Figure 1:
Geographical Distribution of IIH In The United States From 1990 to 2024.
Figure 2:
Figure 2:
IIH Incidence and Prevalence Time-Based Trends Over Gender, Age and Race Subgroups.
See this image and copyright information in PMC

Update of

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