Idiopathic intracranial hypertension: Clinical nosography and field-testing of the ICHD diagnostic criteria. A case-control study

Aims The aims of this article are to characterize the headache in idiopathic intracranial hypertension (IIH) and to field-test the ICHD diagnostic criteria for headache attributed to IIH. Materials and methods We included 44 patients with new-onset IIH. Thirty-four patients with suspected but unconf...

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Bibliographic Details
Published in:Cephalalgia 2015-06, Vol.35 (7), p.553-562
Main Authors: Yri, Hanne M, Jensen, Rigmor H
Format: Article
Language:English
Subjects:
Adult
Case-Control Studies
Cough - complications
Cough - diagnosis
Cough - therapy
Female
Headache - complications
Headache - diagnosis
Headache - therapy
Humans
Male
Prospective Studies
Pseudotumor Cerebri - complications
Pseudotumor Cerebri - diagnosis
Pseudotumor Cerebri - therapy
Spinal Puncture - methods
Spinal Puncture - standards
Young Adult
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Summary:Aims The aims of this article are to characterize the headache in idiopathic intracranial hypertension (IIH) and to field-test the ICHD diagnostic criteria for headache attributed to IIH. Materials and methods We included 44 patients with new-onset IIH. Thirty-four patients with suspected but unconfirmed IIH served as controls. Headache and other IIH-related symptoms were assessed by a detailed standardized interview. In participants referred before diagnostic lumbar puncture (n = 67), we recorded headache intensity before and after cerebrospinal fluid (CSF) withdrawal. Results Headache in patients with IIH was daily occurring in 86%, focal in 84% and pulsating in 52%. Aggravation of headache by coughing or straining and relief after CSF withdrawal were significantly more frequent in patients than in controls (p ≤ 0.002). From the ICHD-2 to the ICHD-3 beta classification the sensitivity increased from 60% to 86% whereas the specificity decreased from 86% to 53%. Based on our data the headache criteria can be revised to increase sensitivity to 95% and specificity to 65%. Conclusion Aggravation of headache by coughing or straining, relief after CSF withdrawal, retrobulbar pain and pulsatile tinnitus may suggest intracranial hypertension. Based on data from a well-defined IIH cohort, we propose a revision of the ICDH-3 beta diagnostic criteria with improved clinical applicability and increased sensitivity and specificity.
ISSN:0333-1024
1468-2982
DOI:10.1177/0333102414550109