Intracranial pressure directly predicts headache\xa0morbidity in idiopathic intracranial hypertension

S P Mollan,A Gupta,J Mitchell,O Grech,R Ottridge,G Lavery,A J Sinclair,Z Alimajstorovic,B R Wakerley,K Brock,M Thaller,A Yiangou

doi:10.1186/s10194-021-01321-8

Abstract

ObjectiveHeadache is the predominant disabler in idiopathic intracranial hypertension (IIH). The aim was to characterise headache and investigate the association with intracranial pressure.MethodsIIH:WT was a randomised controlled parallel group multicentre trial in the United Kingdom investigating weight management methods in IIH. Participants with active IIH (evidenced by papilloedema) and a body mass index (BMI) ≥35 kg/m2 were recruited. At baseline, 12 months and 24 months headache characteristics and quality of life outcome measures were collected and lumbar puncture measurements were performed.ResultsSixty-six women with active IIH were included with a mean age of 32.0 years (SD ± 7.8), and mean body mass index of 43.9 ± 7.0 kg/m2. The headache phenotype was migraine-like in 90%. Headache severity correlated with ICP at baseline (r = 0.285; p = 0.024); change in headache severity and monthly headache days correlated with change in ICP at 12 months (r = 0.454, p = 0.001 and r = 0.419, p = 0.002 respectively). Cutaneous allodynia was significantly correlated with ICP at 12 months. (r = 0.479, p < 0.001). Boot strap analysis noted a positive association between ICP at 12 and 24 months and enabled prediction of both change in headache severity and monthly headache days. ICP was associated with significant improvements in quality of life (SF-36).ConclusionsWe demonstrate a positive relationship between ICP and headache and cutaneous allodynia, which has not been previously reported in IIH. Those with the greatest reduction in ICP over 12 months had the greatest reduction in headache frequency and severity; this was associated with improvement of quality of life measures.Trial registrationThis work provides Class IIa evidence of the association of raised intracranial pressure and headache. ClinicalTrials.gov number, NCT02124486.

Highlights

Idiopathic intracranial hypertension (IIH) is a rare disease that is increasingly recognised [1, 2]
Patient characteristics Sixty-six persons (100% women) with active IIH were included in the analysis (Table 1)
We demonstrate a positive relationship between intracranial pressure (ICP) and headache severity and monthly headache days, which has not been noted previously in IIH

Summary

Introduction

Idiopathic intracranial hypertension (IIH) is a rare disease that is increasingly recognised [1, 2]. It is characterized by raised intracranial pressure (ICP) in the absence of a structural cause on brain imaging [3, 4]. The exact cause of IIH remains unknown, disease development is associated with obesity and there is increasing evidence to suggest adipose dysfunction [5]. The International Classification of Headache Disorders (ICHD-3 beta) attributes headache in IIH to be associated with raised intracranial pressure and acknowledges that it often mimics primary headache disorders such as migraine [9]. Calcitonin gene-related peptide (CGRP) monoclonal antibodies have been noted in a prospective study to significantly improve headache in patients with IIH and persistent post-IIH headache (resolved papilloedema), suggesting CGRP may modulate headache pain [13, 14]

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