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
. 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.

PubMed Disclaimer

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

Similar articles

See all similar articles

Cited by

References

    1. Mollan SP, Aguiar M, Evison F, Frew E, Sinclair AJ. The expanding burden of idiopathic intracranial hypertension. Eye (London, England). 2019: 478 [ 10.1038/s41433-018-0238-5: 10.1038/s41433-018-0238-5] - DOI - PMC - PubMed
    1. Ko MW, Chang SC, Ridha MA, Ney JJ, Ali TF, Friedman DI, Mejico LJ, Volpe NJ, Galetta SL, Balcer LJ, Liu GT. Weight gain and recurrence in idiopathic intracranial hypertension: a case-control study. Neurology. 2011: 1564 [ 10.1212/WNL.0b013e3182190f51: 10.1212/WNL.0b013e3182190f51] - DOI - PubMed
    1. Westgate CS, Botfield HF, Alimajstorovic Z, Yiangou A, Walsh M, Smith G, Singhal R, Mitchell JL, Grech O, Markey KA, Hebenstreit D, Tennant DA, Tomlinson JW, Mollan SP, Ludwig C, Akerman I, Lavery GG, Sinclair AJ. Systemic and adipocyte transcriptional and metabolic dysregulation in idiopathic intracranial hypertension. JCI insight. 2021: [ 10.1172/jci.insight.145346: 10.1172/jci.insight.145346] - DOI - PMC - PubMed
    1. Mollan SP, Grech O, Alimajstorovic Z, Wakerley BR, Sinclair AJ. New horizons for idiopathic intracranial hypertension: advances and challenges. British medical bulletin. 2020: 118 [ 10.1093/bmb/ldaa034: 10.1093/bmb/ldaa034] - DOI - PubMed
    1. McCluskey G, Doherty-Allan R, McCarron P, Loftus AM, McCarron LV, Mulholland D, McVerry F, McCar ron MO. Meta-analysis and systematic review of population-based epidemiological studies in idiopathic intracranial hypertension. European journal of neurology. 2018: 1218 [ 10.1111/ene.13739: 10.1111/ene.13739] - DOI - PubMed

LinkOut - more resources