Materiały źródłowe

• #1 Prevention and treatment of intracranial hypertension – PubMed

  https://pubmed.ncbi.nlm.nih.gov/18286835/

  Intracranial hypertension is caused by hematoma, contusion, tumor, hygroma, hydrocephalus or pneumatocephalus, surgical treatment is indicated. […] In the absence of a surgically treatable condition, ICP may be controlled by correcting the patient’s position, temperature, ventilation or hemodynamics. […] If intracranial hypertension persists, drainage of CSF via external drainage is most effective. […] Other first-tier options include induced hypocapnea (hyperventilation; paCO2 35 mmHg), hyperosmolar therapy (mannitol, hypertonic saline) and induced arterial hypertension (CPP concept). […] When autoregulation of cerebral blood flow is compromised, hyperoncotic treatment aimed at reducing vasogenic edema and intracranial blood volume may be applied. […] When intracranial hypertension persists, second-tier treatments may be indicated. […] The last resort is emergent bilateral decompressive craniectomy; once taken into consideration, it should be performed without undue delay.

• #2 Idiopathic intracranial hypertension: consensus guidelines on management | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/89/10/1088

  The aim was to capture interdisciplinary expertise from a large group of clinicians, reflecting practice from across the UK and further, to inform subsequent development of a national consensus guidance for optimal management of idiopathic intracranial hypertension (IIH). […] The main principles of management of IIH are: (1) to treat the underlying disease; (2) to protect the vision; and (3) to minimise the headache morbidity. […] Weight loss reduces ICP and has been shown to be effective in improving papilloedema and headaches. […] Once definite IIH is diagnosed, all patients with a BMI 30kg/m2 should be counselled about weight management at the earliest opportunity. […] Where there is evidence of declining visual function, the acute management to preserve vision is surgical. […] A temporising measure of a lumbar drain could be useful to protect the vision while planning urgent surgical treatment.

• #3 Idiopathic Intracranial Hypertension: Causes, Symptoms, and Treatment

  https://patient.info/brain-nerves/idiopathic-intracranial-hypertension-leaflet

  In idiopathic intracranial hypertension there is raised pressure within the skull (raised intracranial pressure), which puts pressure on the brain. […] Treatment is aimed at preventing permanent visual loss and includes treatment with medicines. […] If papilloedema is not recognised and treated, it can cause damage to the optic nerve. This can lead to vision problems, including blindness. […] It is essential to detect idiopathic intracranial hypertension early and to start treatment early to prevent permanent loss of vision occurring. […] For people with overweight or obesity, weight loss can be a very effective treatment for idiopathic intracranial hypertension. Research shows that losing 5-10% of body weight can significantly improve symptoms of IIH, and sometimes causes the condition to go into remission. […] There are two main aims of treatment for idiopathic intracranial hypertension: To improve, and hopefully cure, the headaches. […] To prevent visual loss.

• #4 Idiopathic Intracranial Hypertension: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21968-idiopathic-intracranial-hypertension

  You cant prevent IIH because the cause isnt well understood. You can help reduce your risk of developing the condition by maintaining a healthy weight thats appropriate for you. A healthcare provider can help you manage any risk factors for IIH, too. […] To prevent IIH from happening again, your provider may suggest making lifestyle changes to improve your overall health. This could include participating in a weight management program if you have a BMI over 30.

• #5 Idiopathic Intracranial Hypertension (IIH) Treatment & Management: Approach Considerations, Pharmacologic Therapy, Optic Nerve Sheath Fenestration, CSF Diversion, and Venous Sinus Stenting

  https://emedicine.medscape.com/article/1214410-treatment

  Idiopathic intracranial hypertension (IIH) has no known cause and no known methods of prevention. Among patients who have been diagnosed with IIH, the goal is to prevent further visual loss and comorbid symptoms, including headache. Progression of IIH is prevented through medical and surgical treatment, as well as diet and lifestyle modifications to reduce body weight. […] For obese patients, weight management and a low-sodium diet are consistently emphasized. Additionally, any exogenous agents that could potentially elevate ICP should be discontinued. […] In cases where obesity is a factor, weight reduction is advised to significantly decrease intracranial pressure. For patients unable to lose weight through traditional methods, bariatric surgery, possibly supported by medications like GLP-1 receptor agonists, may be an effective solution.

• #6 Idiopathic Intracranial Hypertension

  https://healthlibrary.gradyhealth.org/Library/Encyclopedia/134,57

  Obesity has been linked to IIH. So eating a healthy, low-fat diet and getting plenty of exercise may help reduce your risk for the condition. […] Seeing a healthcare provider right away to diagnose symptoms and begin treatment can help to prevent complications. […] Eating a healthy, low-fat diet and getting plenty of exercise may help reduce your risk for IIH.

• #7 Current Overview of Idiopathic Intracranial Hypertension | 2021, Volume 27 – Issue 3 | Turkish Journal of Neurology

  https://www.tjn.org.tr/full-text/157/eng

  Studies and clinical observations on the effectiveness of weight control in IIH strongly support weight loss as an effective treatment. […] With a 6-10% loss of the current weight, clinical improvement is observed in various parameters, including ICP, papilledema, and headache. […] Therefore, in patients with high BMI, the development of strategies for weight loss should be started at the patients first presentation, and they should be carefully and repeatedly instructed that weight control is one of the most important treatment steps. […] Medical treatment options should be considered in normal-weight patients with IIH or when the diet alone is insufficient. […] Acetazolamide, a potent carbonic anhydrase enzyme inhibitor, acts by reducing CSF secretion from the choroid plexuses. […] New treatments, which will reduce ICP faster than the existing methods, are being studied.

• #8 Idiopathic Intracranial Hypertension (IIH) Medication: Antiglaucoma, Carbonic Anhydrase Inhibitors, Loop diuretics, Cardiovascular, Other, Corticosteroids, Beta-Blockers, Tricyclic Antidepressants, Antiepileptics, Antidiabetics, Glucagon-like Peptide-1 Ag

  https://emedicine.medscape.com/article/1214410-medication

  Specific therapy for idiopathic intracranial hypertension (IIH) is aimed at lowering ICP pharmacologically. […] Carbonic anhydrase inhibitors (eg, acetazolamide) and loop diuretics (eg, furosemide) are thought to exert their effect on ICP by reducing cerebrospinal fluid (CSF) production at the choroid plexus. […] Corticosteroids are indicated on a short-term basis in patients who present with severe papilledema and compromised visual function. […] Patients with IIH may experience headaches that have many of the features of migraine. […] Topiramate also is an excellent choice, in that one of its side effects is weight loss (a common association in IIH), which can help put the disease in remission. […] Tirzepatide is commonly used to treat type-2 diabetes. It’s weight loss effects also contribute to therapeutic benefits through reduced intracranial venous pressure. […] Exenatide is commonly used to treat type-2 diabetes and obesity. Recent studies also show that it can reduce CSF secretion and ICP.

• #9

  https://link.springer.com/article/10.1007/s00415-022-11402-6

  There are limited longitudinal data evaluating outcomes in idiopathic intracranial hypertension (IIH). […] Improving prognosis in IIH should focus on the potentially modifiable factor of weight management. […] Weight loss is currently the only known disease modifier in IIH and the recent IIH Weight Trial showed that bariatric surgery was superior over community weight management in lowering the intracranial pressure with it also being cost-effective. […] The change in BMI was the most influential factor affecting PMD, RNFL and macular GCL volume outcomes. […] Body weight modification and disease duration appear to have the main influence for visual outcomes, and hence why we would recommend active early weight management for patients with IIH with a raised BMI.

• #10 Idiopathic Intracranial Hypertension(IIH) AKA High Pressure in the Brain: Paddy Kalish, OD: Optometrist

  https://www.paddykalish.com/blog/idiopathic-intracranial-hypertensioniih-aka-high-pressure-in-the-brain

  IIH is not benign: IIH is not a benign disorder, and many patients experience debilitating headaches. […] Treatments for IIH include: Diuretics to reduce spinal fluid production, Surgery to relieve pressure, Weight loss, and Relaxation methods. […] Have regular eye exams and checkups treat any eye problems before they get worse. […] Address risk factors and comorbid conditions Any potential agents that might cause or worsen IIH (eg, tetracycline derivatives) should be discontinued. […] Weight loss A low-sodium weight reduction program, ideally in conjunction with a nutritionist or dietician, is recommended for all patients with obesity and IIH. […] Studies typically report that weight loss is associated with reductions in intracranial pressure (ICP) and/or papilledema. […] Medically supervised weight loss programs or surgically induced weight reduction (eg, gastric banding or gastric bypass procedures) may be necessary in patients with severe obesity.

• #11

  https://continentalhospitals.com/diseases/idiopathic-intracranial-hypertension/

  Prevention is a crucial aspect when it comes to managing idiopathic intracranial hypertension (IIH). While the exact cause of IIH is still unknown, there are several steps that individuals can take to potentially reduce their risk and prevent the onset or progression of this condition. Maintaining a healthy lifestyle is paramount in preventing IIH. This includes adopting a balanced diet that is low in sodium and high in fruits, vegetables, and whole grains. Regular exercise can also play a significant role in managing weight, which is often associated with IIH. Additionally, managing stress levels and getting enough sleep are essential preventive measures. Chronic stress and lack of sleep have been linked to various health conditions, including increased intracranial pressure. For individuals who are overweight or obese, losing weight has shown promising results in reducing the symptoms of IIH. Weight loss can be achieved through a combination of healthy eating habits and regular physical activity. Also, it is crucial to monitor any medications that may contribute to increased intracranial pressure. Certain medications such as hormonal contraceptives or steroids have been associated with IIH development or exacerbation.

• #12 MEDSAFE

  https://www.medsafe.govt.nz/profs/puarticles/bih.htm

  Benign intracranial hypertension (BIH) is a rare but potentially serious condition. BIH has been documented in association with a variety of medicines, particularly the tetracyclines. […] If associated with a medicine, the condition may resolve totally on stopping it. Treatment includes therapeutic lumbar punctures and acetazolamide. […] Doctors should regularly enquire about headache when prescribing a tetracycline, even for a short period. The combination of a tetracycline and isotretinoin should be avoided. […] Active intervention may not be needed in the absence of visual defects and if there is an association with a medicine which has been discontinued. Treatment includes weight loss if indicated, repeated lumbar punctures until the intracranial pressure returns to normal, and oral acetazolamide. […] When BIH is suspected, the medicine must be stopped and a neurological opinion promptly sought. The same precautions should be observed when prescribing tetracyclines of any kind for malaria prophylaxis (an unapproved use in New Zealand).

• #13

  https://continentalhospitals.com/diseases/benign-intracranial-hypertension/

  One of the key strategies for prevention is maintaining a healthy lifestyle. This includes adopting a well-balanced diet, engaging in regular physical activity, and managing weight within a healthy range. By doing so, individuals can lower the chances of developing conditions such as obesity or hypertension, which are known to be risk factors for benign intracranial hypertension. […] Additionally, it is important to prioritize regular eye exams. These examinations can help detect any potential vision changes or abnormalities that may be associated with benign intracranial hypertension. Early detection and intervention can significantly improve outcomes and prevent further complications. […] Furthermore, individuals should be cautious when using certain medications that have been linked to an increased risk of benign intracranial hypertension. It is advisable to consult with healthcare professionals before starting any new medications or making changes to existing ones.

• #14 Idiopathic Intracranial Hypertension: Symptoms, Treatment, More

  https://www.healthline.com/health/idiopathic-intracranial-hypertension

  The most effective thing you can do to avoid having IIH is to lose weight if you have obesity or overweight. An increased risk of IIH has also been linked to rapid weight gain, even for people without obesity. […] If you think you might have IIH, getting treatment quickly can help to prevent serious complications. Consult with a doctor if you believe you have IIH.

• #15 Idiopathic Intracranial Hypertension – Preserve Vision FloridaEvent SeriesEvent SeriesEvent SeriesEvent Series

  https://pvfla.org/idiopathic-intracranial-hypertension/

  If a diagnosis of IIH is confirmed, regular visual field tests and comprehensive dilated eye exams are recommended to monitor any changes in vision. […] Sustainable weight loss through healthy eating, salt restriction, and exercise is a critical part of treatment for people with IIH who are overweight. Studies show that modest weight loss, around 5-10 percent of total body weight, may be sufficient to reduce signs and symptoms. […] In rapidly progressive cases that do not respond to other treatments, surgery may be needed to relieve pressure on the optic nerve. Therapeutic shunting, which involves surgically inserting a tube to drain CSF from ventricles or inner brain cavities, can be used to remove excess CSF and lower pressure.

• #16 When to Call, When to Counsel: Acetazolamide for Idiopathic Intracranial Hypertension

  https://www.pharmacytimes.com/view/when-to-call-when-to-counsel-acetazolamide-for-idiopathic-intracranial-hypertension

  Historically, acetazolamide has been used as prophylaxis for altitude sickness and as an adjunct treatment for glaucoma; however, there is an emerging trend in health care for the off-label use of acetazolamide. This off-label use can be found in all age groups to treat idiopathic intracranial hypertension (IIH). […] The goal of treatment is to regain baseline patient vision and alleviate symptoms, which requires aggressive treatment to preserve vision upon diagnosis and prevent further worsening of the visual field. […] Recommended monitoring parameters for patients include comprehensive metabolic panels, visual field tests, optic disc, and nerve imaging (optical coherence tomography) on a frequent yet clinician-specific basis. […] Electrolyte imbalance, acid/base disorders, weight/appetite, and neurologic symptoms are also essential to monitor for all patients taking acetazolamide. […] Ultimately, the better you know your patients, the more you can prevent medication-related problems and improve adherence.

• #17 Managing idiopathic intracranial hypertension in pregnancy: practical advice | Practical Neurology

  https://pn.bmj.com/content/22/4/295

  Idiopathic intracranial hypertension (IIH) is more common in women of reproductive age who have obesity, yet there is little information on its management specifically in pregnancy. […] Women with IIH should plan their pregnancy including discussing contraception before pregnancy, recognising that hormonal contraceptives are not contraindicated. […] Ideally, patients should aim to achieve disease remission or control before pregnancy, through optimising their weight. […] Although weight gain is expected in pregnancy, excessive weight gain may exacerbate IIH and increase maternal and fetal complications; evidence-based recommendations for non-IIH pregnancies may help in guiding optimal gestational weight gain. […] The vast majority of women with IIH can have a normal vaginal delivery, with spinal or epidural anaesthesia if needed, provided the papilloedema is stable or the IIH is in remission.

• #18 Managing idiopathic intracranial hypertension in pregnancy: practical advice | Practical Neurology

  https://pn.bmj.com/content/22/4/295

  Hormonal contraceptives are not contraindicated in IIH and there is no preferred contraceptive method. […] When a woman with IIH wishes to conceive, the aim is to achieve disease remission or stable disease with mild papilloedema. […] Women of childbearing age need to have a careful risk-benefit discussion about medications that may be teratogenic. […] Acetazolamide, a carbonic anhydrase inhibitor, is the most commonly used medication in IIH. […] However, there is a high (48%) likelihood of discontinuation due to adverse effects when using a mean daily dose of 1.5g. […] Women should be counselled that acetazolamide is potentially teratogenic and its prescription in pregnancy must only follow discussion with the patient and their obstetrician. […] Body weight is a potentially modifiable risk factor in IIH; thus, women ideally should achieve a healthy body weight before conception.

• #19 Managing idiopathic intracranial hypertension in pregnancy: practical advice | Practical Neurology

  https://pn.bmj.com/content/22/4/295

  Weight management is a key issue in IIH. Weight loss is disease-modifying and can put IIH into remission whereas weight gain can exacerbate it. […] Excessive weight gain during pregnancy also increases the risk of complications for baby and mother. […] Providing advice to pregnant women with IIH on how to approach weight gain in pregnancy is essential. […] We recommend an individualised approach so as not to obscure important biocultural factors, including socioeconomic status, ethnicity and comorbidities. […] Many factors may influence management decisions, including IIH disease activity, risk of deterioration and prepregnancy BMI. […] A combined approach of diet, physical activity and behaviour change approaches has good evidence to reduce gestational weight gain. […] This can significantly increase the long-term weight gain trajectory of a woman of childbearing age, particularly if she has multiple pregnancies, and therefore, potentially increases the risk of IIH deterioration or recurrence.

• #20 Managing idiopathic intracranial hypertension in pregnancy: practical advice | Practical Neurology

  https://pn.bmj.com/content/22/4/295

  Patients with IIH do not need any specific mode of delivery and there is no clear evidence to support the reported trend towards caesarean section. […] However, we would advise caution in those rarer cases with severe papilloedema who have rapidly declining vision at delivery; such patients should be managed in a specialist centre. […] An important aspect is the risk of weight gain during pregnancy, as this can exacerbate IIH. […] We recommend increased frequency of IIH outpatient reviews during pregnancy to identify any clinical deterioration early and provide reassurance.

• #21 Idiopathic intracranial hypertension: consensus guidelines on management | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/89/10/1088

  The role of neurovascular stenting in IIH is not yet established. […] For optimal management of patients with IIH, there must be clear communication between clinicians for seamless joint care between the various specialties. […] CSF diversion is generally not recommended as a treatment for headache alone in IIH. […] In collaboration with many different experienced clinicians, professions and patient representatives, we have developed guidance statements for the investigation and management of adult IIH.

• #22 Idiopathic intracranial hypertension | MedLink Neurology

  https://www.medlink.com/articles/idiopathic-intracranial-hypertension

  At present, there is no known method to prevent idiopathic intracranial hypertension, although maintaining a normal weight is likely useful. […] The Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) provides evidence-based therapy for patients who have mild visual loss. […] A team approach to management is ideal, and a team leader (generally a neurologist or neuro-ophthalmologist) is critical.

• #23 Neurology idiopathic intracranial hypertension clinic | Dayton Children’s Hospital

  https://www.childrensdayton.org/patients-visitors/services/neurology/services-and-programs/idiopathic-intracranial-hypertension

  Dayton Childrens neurology department offers a specialty clinic for care for idiopathic intracranial hypertension syndrome (IIH) that brings together a team of experts in one convenient appointment. […] This multidisciplinary approach is beneficial for clear communication and holistic care, leading to the best clinical outcomes for the child. […] Since the majority of IIH patients have an unhealthy weight, weight loss is recommended. Healthy eating and exercise are a critical part of treatment for these patients. Losing weight can reduce CSF intracranial pressure, optic nerve swelling and headaches, and can help lead to remission. Studies have shown that patients have reported improvement in their symptoms after losing as low as 5-10 percent of their total body weight. […] The doctor might also prescribe a medicine to lower the CSF pressure and improve the symptoms while you continue to make efforts to lose weight. One of these medications is called Acetazolamide (Diamox), which helps lower CSF production.

• #24 Idiopathic Intracranial Hypertension – Your Questions Answered

  https://www.clevelandclinicabudhabi.ae/en/health-hub/health-resource/diseases-and-conditions/idiopathic-intracranial-hypertension-your-questions-answered

  Weight is closely linked to IIH, as obesity is a significant risk factor for the development and worsening of the condition. […] Effective weight management/weight loss is often a crucial part of IIH treatment to help alleviate symptoms, prevent disease progression and improve or even resolve the condition. […] It’s important for individuals with IIH to work closely with a healthcare team, including neurologists, neuro-ophthalmologists, and dietitians, to determine the most appropriate and effective treatment plan for their specific situation. Weight loss, when recommended, should be part of a comprehensive approach to managing IIH. […] Managing IIH can be a long-term process. Always talk to your medical team to discuss any concerns or preferences you have, as this will ensure an appropriate treatment plan which is personalized to you, and the best chance of improving symptoms and preventing vision loss.

• #25 How I manage intracranial hypertension | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2529-z

  The detrimental effects of intracranial hypertension (HICP, high intracranial pressure) are well documented. HICP can cause secondary brain injury and death, and therefore, intracranial pressure (ICP) elevations should be aggressively treated. […] HICP has been classically defined as an ICP 20mmHg, and this threshold has been considered the trigger for treatment. Recent BTF guidelines have moved this threshold to 22mmHg, grounded on a single-centre, retrospective study. This modification is trivial. […] In my practice, the ICP alarm is set at 20mmHg and low CPP alarm at 55mmHg. This is a warning signal for nurses at the bedside. Before starting any treatments for high ICP, I consider both the intensity and duration of HICP. […] I always consider the surgical option with a neurosurgeon; mass-occupying space should be promptly evacuated when indications are met, and hydrocephalus should be drained.

• #26 How I manage intracranial hypertension | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2529-z

  Summary of the available ICP-directed therapies. Before starting an HICP-directed therapy, I consider removing confounders. These factors need to be corrected early with specific therapeutical manoeuvres. […] I generally reserve to patients with refractory intracranial hypertension ICP-lowering strategies associated with significant side effects and potential complications as hyperventilation, metabolic suppression and decompressive craniectomy. […] Barbiturates have been historically used for decreasing brain metabolism and consequently cerebral blood flow/volume and therefore HICP at the cost of serious side effects including hypotension and infections. […] For these reasons, DC needs to wisely ponder in the context of refractory HICP and it should be undertaken timely in subjects with a potentially acceptable prognosis (i.e. before irreversible damages occurred), considering individual patients preferences and familys quality of life expectations. […] This will allow me to deescalate ICP-lowering strategies as soon as possible (ICP control 24h). Tapering therapies (as hyperventilation and osmotic) might produce a rebound effect, and it needs to be done slowly and under ICP monitoring.

• #27 Increased Intracranial Pressure (ICP): Symptoms and Treatments

  https://www.healthline.com/health/increased-intracranial-pressure

  You cant prevent increased ICP, but you can prevent head injury. […] Always wear a helmet when you bike or play contact sports. Wear your seatbelt when driving and keep your seat back as far as possible from the dashboard or the seat in front of you. Always buckle children into a child safety seat. […] Falling at home is a common cause of head injury, especially in older adults. Avoid falls at home by keeping floors dry and uncluttered. If necessary, install handrails.

• #28 Idiopathic intracranial hypertension – Wikipedia

  https://en.wikipedia.org/wiki/Idiopathic_intracranial_hypertension

  The best-studied medical treatment for intracranial hypertension is acetazolamide (Diamox), which acts by inhibiting the enzyme carbonic anhydrase, and it reduces CSF production by six to 57 percent. […] Venous sinus stenoses leading to venous hypertension appear to play a significant part in relation to raised ICP, and stenting of a transverse sinus may resolve venous hypertension, leading to improved CSF resorption, decreased ICP, cure of papilledema and other symptoms of IIH. […] Two main surgical procedures are used for the treatment of IIH: optic nerve sheath decompression and fenestration and cerebral shunting. Surgery would normally only be offered if medical therapy is either unsuccessful or not tolerated.

• #29 Idiopathic Intracranial Hypertension – Neurology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.25.2.

  Weight Management […] All patients should be counseled about weight management. A loss of 5% to 10% of initial body weight is often enough to induce remission in most patients with IIH. […] Acetazolamide, a carbonic anhydrase inhibitor, decreases the production of CSF and is the main medical treatment for IIH, especially in those in whom weight loss is ineffective or not achieved. […] Surgery should be considered in patients with evidence of declining visual function and imminent risk of vision loss. The surgical intervention of choice often depends on local resources and availability. Interventions fall within 3 categories: […] Management of an individual patient depends on the severity of vision loss as determined by formal perimetry, degree of papilledema, and severity of headaches. […] IIH is a chronic disease and patients need long-term monitoring. Recurrences are often due to weight gain and thus it is important to emphasize the need to achieve and sustain weight loss.

• #30 Idiopathic Intracranial Hypertension, Pseudotumor cerebri – EyeRounds.org – Ophthalmology – The University of Iowa

  http://eyerounds.org/cases/99-pseudotumor-cerebri.htm

  Intractable headache or progression of visual loss despite maximal medical treatment requires surgical therapy. The primary surgical options are optic nerve sheath fenestration or a CSF diversion procedure (shunt). […] Other medications that can be used are topiramate and furosemide. With severe visual loss, surgery can be done immediately or after a short medical trial. Steroids can be used to lower pressure while the patient is awaiting a CSF shunting procedure.

• #31

  https://journals.lww.com/co-neurology/fulltext/2019/02000/advances_in_the_understanding_of_headache_in.16.aspx

  To review the most relevant developments in the understanding of headache in idiopathic intracranial hypertension (IIH). […] Headache management is an unmet need in IIH and future studies are required to investigate the probable complex mechanisms, as well as effective management. […] The 2015 Cochrane review concluded that there is a lack of evidence to guide pharmacological treatment in IIH. […] Managing headache in IIH is an essential aspect of patient care and recent consensus guidelines have provided a practical approach to managing them. […] As migraine is the predominant phenotype, the use of migraine therapies has been recommended. […] Migraine attacks may benefit from triptan acute therapy used in combination with either a nonsteroidal anti-inflammatory or paracetamol and an antiemetic with pro-kinetic properties.

• #32

  https://journals.lww.com/co-neurology/fulltext/2019/02000/advances_in_the_understanding_of_headache_in.16.aspx

  Caution should be observed before selecting drugs that could increase weight such as -blockers, tricyclic antidepressants, sodium valproate, pizotifen and flunarizine. […] It seems prudent that all IIH patients with headaches are warned about avoiding excessive analgesic use and where MOH exists standard advice of removal given. […] Professional bodies in the United Kingdom and Europe do not advocate therapeutic lumbar puncture as a treatment strategy for IIH. […] CSF shunting to exclusively treat headache in IIH has limited evidence. […] There is uncertainty that failure to optimise ICP may render the migraine headaches difficult to treat, and if headache was indicated for CSF shunting, then a period of ICP monitoring preoperatively may be useful to determine the success of the proposed procedure.

• #33

  https://journals.lww.com/co-neurology/fulltext/2019/02000/advances_in_the_understanding_of_headache_in.16.aspx

  Migraine phenotype and prior history of headache before a diagnosis of IIH needs to be recognised by clinicians to avoid misdiagnosis. […] There is an unmet need to treat headaches in IIH. Future studies should consider core outcome measures for headache, as used in migraine trials, which would optimise meta-analysis.

• #34 Idiopathic Intracranial Hypertension(IIH) AKA High Pressure in the Brain: Paddy Kalish, OD: Optometrist

  https://www.paddykalish.com/blog/idiopathic-intracranial-hypertensioniih-aka-high-pressure-in-the-brain

  Weight gain may be a risk factor for recurrence of IIH. […] Carbonic anhydrase inhibitors are believed to reduce the rate of CSF production and have been associated with modestly improved outcomes in patients with IIH. […] Patients with IIH can continue to have headaches despite improvement in papilledema and visual function. […] Many patients with headaches and IIH have migraine or another headache syndrome that is not directly related to increased ICP. […] Treatment is urgent to preserve vision: Acetazolamide should be initiated promptly and can be rapidly titrated up to 4 grams per day divided into two doses. […] In addition, short-term temporizing measures can be employed in such patients until surgery can be performed. […] Indications for intervention Patients with IIH who appear to benefit from surgical intervention include those who fail, are intolerant to, or are noncompliant with maximum medical therapy.

• #35 Current Overview of Idiopathic Intracranial Hypertension | 2021, Volume 27 – Issue 3 | Turkish Journal of Neurology

  https://www.tjn.org.tr/full-text/157/eng

  Surgical treatment options include optic nerve sheath fenestration (ONSF), venous sinus stenting (VSS), ventriculoperitoneal (Vp) and lumboperitoneal (Lp) shunt, and bariatric surgery. […] The choice and timing of surgical treatment are controversial as there are no adequate prospective randomized-controlled studies comparing these treatments. […] The exact indications for bariatric surgery in IIH are unclear. […] All bariatric surgical methods cause more weight loss compared with non-surgical interventions. […] The fact that weight loss is the only disease-modifying treatment option and bariatric surgery has a lower cost and is safer than shunt operations may make bariatric surgery more prominent among IIH treatment options in the coming years. […] In this disease, where the main goal is to preserve visual functions, the 10% rate of development of permanent vision loss requires appropriate treatment options to be started at the appropriate time. […] Due to the high risk of recurrence, it is recommended that patients be followed up closely for a long time with BMI control, visual field test, visual acuity, and fundus evaluation.

• #36 Idiopathic Intracranial Hypertension(IIH) AKA High Pressure in the Brain: Paddy Kalish, OD: Optometrist

  https://www.paddykalish.com/blog/idiopathic-intracranial-hypertensioniih-aka-high-pressure-in-the-brain

  The overall rate of visual improvement seems to be equivalent across all of the surgical treatment modalities, and there is insufficient evidence to recommend or reject any one surgical modality over another at this time. […] ONSF appears to be an effective procedure in patients who have progressive vision loss despite medical therapy. […] Preservation of vision is the primary goal of ONSF. […] ONSF has been associated with improvement in patients with deteriorating vision loss despite a working shunt. […] Venous sinus stenting is a relatively new and somewhat controversial treatment option for IIH.

• #37 Current Overview of Idiopathic Intracranial Hypertension | 2021, Volume 27 – Issue 3 | Turkish Journal of Neurology

  https://tjn.org.tr/doi/10.4274/tnd.2021.45649

  New treatments, which will reduce ICP faster than the existing methods, are being studied. […] Surgical treatment options include optic nerve sheath fenestration (ONSF), venous sinus stenting (VSS), ventriculoperitoneal (Vp) and lumboperitoneal (Lp) shunt, and bariatric surgery. […] The choice and timing of surgical treatment are controversial as there are no adequate prospective randomized-controlled studies comparing these treatments. […] The rate of treatment failure, defined as worsening of visual complaints or recurrence of headache in a patient whose symptoms have improved after surgery, is lowest in ONSF and highest in shunt operations. […] In patients resistant to the highest tolerable dose of medical therapy and experience progressive vision loss, the decision of the appropriate surgical method should be made based on the complication rates of the procedure. […] It is important to be meticulous in terms of diagnosis and classification of accompanying symptoms. […] Due to the high risk of recurrence, it is recommended that patients be followed up closely for a long time with BMI control, visual field test, visual acuity, and fundus evaluation.

• #38 Treatment of Papilledema from Idiopathic Intracranial Hypertension | Rush

  https://www.rush.edu/treatment-papilledema-idiopathic-intracranial-hypertension

  Consistent with the standard of care, I treated the patient with acetazolamide to lower the intracranial pressure and discussed the role that weight loss can play in the management of the disease. […] For most patients, IIH can be cured through a combination of weight loss and medication management. It is critical to closely monitor visual fields with formal Humphrey visual field testing and to monitor nerve edema with examination and OCT testing to evaluate the efficacy of the medications we are using. Ultimately, despite optimal medical management, more invasive treatments may be needed.

• #39 Guideline for Diagnosis and Treatment of Idiopathic Intracranial Hypertension – Neurology Advisor

  https://www.neurologyadvisor.com/news/guideline-for-diagnosis-and-treatment-of-idiopathic-intracranial-hypertension/

  The European Headache Federation has issued recommendations on how to best diagnose and treat idiopathic intracranial hypertension. […] The researchers identified several treatment paths for patients with IIH. […] Disease modification through weight loss: There is a clear association between IIH and weight, and weight loss is the only established disease-modifying therapy for IIH. […] Clinicians should recommend weight loss for patients with ongoing raised ICP, which has been shown to significantly improve the Headache Impact Test 6 score. […] Once a diagnosis is established of typical IIH, it requires regular visual monitoring, neurological input for active headache management, and direct counselling regarding weight loss, the researchers wrote.

• #40 Current Overview of Idiopathic Intracranial Hypertension | 2021, Volume 27 – Issue 3 | Turkish Journal of Neurology

  https://www.tjn.org.tr/full-text/157/eng

  Pseudotumor cerebri, also known as idiopathic intracranial hypertension (IIH), is an increment in the intracranial pressure without identifiable causal factors. […] IIH treatment should be arranged considering the severity of headache and papilledema, presence of vision loss, response to medical treatment, and comorbid conditions, with individual planning for each patient. […] Because the pathogenesis of IIH is not fully known, treatment options support different theories. […] The aim is to prevent the risk of developing irreversible complications in patients using different treatments, which have recently been developed. […] The treatment options, including weight loss, medical treatment, and surgical interventions, should be evaluated individually for each patient, according to the presence, degree, and rate of development of vision loss, severity of headache and papilledema, response to medical treatment, comorbid conditions, and tolerability of treatment.

• #41 Intractable Intracranial Hypertension: A Literature Review

  https://www.heraldopenaccess.us/openaccess/intractable-intracranial-hypertension-a-literature-review

  Effective controlling of the Intractable Intracranial Hypertension (IIH) usually comprises careful dodging of features that in most cases do precipitate or increase the intracranial pressure. […] The disorder lowering therapies are normally administered in a procedural way that starts with first-line interventions while at the same time reserving the greater risk option for most patients with intractable intracranial hypertension. […] The management of patients with acute injury of the brain is the central concept behind the prevention of the secondary injuries of the brain which are often the cause of the intractable intracranial hypertension. […] For the treatment of the disease, and early intervention is recommended for those who have shown the symptoms of the disease. […] There is a need for anyone suspected of the symptom of the disease to move quickly and get the recommended intervention for the disorder before it gets to an irreversible state.

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