Idiopathic intracranial hypertension presenting with migraine phenotype is associated with unfavorable headache outcomes

• Published in: Headache 2023-05, Vol.63 (5), p.601-610
• Main Authors: Bsteh, Gabriel, Macher, Stefan, Krajnc, Nik, Pruckner, Philip, Marik, Wolfgang, Mitsch, Christoph, Novak, Klaus, Pemp, Berthold, Wöber, Christian
• Format: Article
• Language: English
• Subjects: Adult; Body mass; Body mass index; Body size; Cerebrospinal fluid; Cerebrospinal Fluid Pressure; Female; Headache; Headaches; Humans; Hypertension; idiopathic intracranial hypertension; Impact analysis; Intracranial Hypertension - complications; Intracranial Hypertension - diagnosis; Male; Migraine; Migraine Disorders - etiology; Optic nerve; outcome; Papilledema - etiology; Phenotypes; Prognosis; Swelling; Vision Disorders - diagnosis; Vision Disorders - etiology; visual; Young Adult
• ISSN: 0017-8748; 1526-4610
• DOI: 10.1111/head.14478

Objective To assess the prognostic impact of migraine headache in idiopathic intracranial hypertension (IIH). Background Migraine headache is common in IIH, but it is unclear whether it has prognostic relevance. Methods We investigated patients with IIH from the Vienna‐IIH‐database and differentiated migraine (IIH‐MIG) from non‐migraine headache (IIH‐nonMIG) and without headache (IIH‐noHA). Using multivariable models, we analyzed the impact of IIH‐MIG on headache and visual outcomes 12 months after diagnosis. Results Among 97 patients (89% female, mean [SD] age 32.9 [11.1] years, median body mass index 32.0 kg/m2, median cerebrospinal fluid opening pressure 310 mm), 46% were assigned to IIH‐MIG, 37% to IIH‐nonMIG (11% tension‐type, 26% unclassifiable), and 17% to IIH‐noHA. Overall, headache improvement was achieved in 77% and freedom of headache in 28%. The IIH‐MIG group showed significantly lower rates for headache improvement (67% vs. 89% in IIH‐nonMIG, p = 0.019) and freedom of headache (11% vs. 33% in IIH‐nonMIG and 63% in IIH‐noHA, p = 0.015). These differences persisted when only analyzing patients with resolved papilledema at follow‐up. In contrast, visual worsening was significantly less common in IIH‐MIG (9% vs. 28% in IIH‐nonMIG and 31% in IIH‐noHA, p = 0.045). In multivariable models, IIH‐MIG was associated with a significantly lower likelihood of achieving headache improvement (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.40–0.78, p