Headache is the most common symptom of idiopathic intracranial hypertension (IIH) and may not resolve with intracranial pressure–lowering treatments. Many patients with IIH have a pre-existing history of migraine. Approximately two-thirds of patients with IIH continue to experience headaches after the other manifestations of the disorder resolve. There are no evidence-based guidelines for treating IIH-related headaches.
This review proposes mechanisms by which IIH produces both acute and ongoing headache. The article analyzes the literature regarding medical and procedural therapies for IIH, apropos to their effectiveness for treating headaches. It then proposes strategies to use in clinical practice, incorporating treatments used for the primary headache disorders of migraine and tension-type headache, the most common phenotypes of IIH-associated headache.
Treatments used to manage primary headache disorders may be effective in the management of IIH-associated headache, although none have been specifically studied in this condition.
Recommendations provided consider a holistic approach to the problem based on existing guidelines and clinical experience.
Departments of Neurology and Neurotherapeutics and Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas.
Address correspondence to Deborah I. Friedman, MD, MPH, 5323 Harry Hines Blvd, MC 9322, Dallas, TX 75390; E-mail: Deborah.Friedman@utsouthwestern.edu
D. I. Friedman serves on advisory boards for Alder Biopharmaceuticals, Allergan, Amgen, Biohaven Pharmaceuticals, Eli Lilly, electroCore, Promius, Supernus, Teva, and Zosano. She has participated on the speakers' bureau for Allergan, Amgen, electroCore, Supernus, and Teva. She receives compensation for editorial services from MedLink Neurology, MedScape, and Neurology Reviews. She has served as an expert witness for both plaintiff and defense counsel in cases of idiopathic intracranial hypertension and is on the board of directors of the American Headache Society and the medical advisory board of the Spinal CSF Leak Foundation.