Manage headache separately from idiopathic intracranial hypertension

 

Headache in idiopathic intracranial hypertension appears to be clinically independent of raised intracranial pressure and may require a different treatment approach than simply lowering intracranial pressure, say the authors of a study published online July 28 in Headache.

The researchers looked at data from 165 patients with untreated idiopathic intracranial hypertension (IIH) and mild vision loss, who were randomized to weight loss plus acetazolamide or placebo as part of the Idiopathic Intracranial Hypertension Treatment Trial.

In the 139 patients who had headaches at baseline, the researchers saw no significant correlation between lumbar puncture opening pressure – which was measured at baseline and 6 months – and Headache Impact Test-6 scores, or with the presence or absence of headache (Headache. 2017 Jul 28. doi: 10.1111/head.13153).

“Both providers and patients often perceive the headache of IIH as being directly linked to CSF [cerebrospinal fluid] pressure elevation, and they anticipate that lowering CSF pressure will improve headache control,” Deborah I. Friedman, MD, of the University of Texas, Dallas, and her coauthors wrote. “Our findings provide the first class I evidence that CSF pressure and headaches are clinically independent features of IIH.”

The study also failed to show any significant difference in headache outcomes between the acetazolamide and placebo groups at 6 months, although headaches in both groups improved overall during the course of the study.

“A substantial proportion of participants had severe headaches at 6 months, stressing the importance of incorporating other headache treatments,” the authors wrote. “These data support the view that additional treatments beyond those used to lower intracranial pressure are needed to treat the headaches associated with IIH.”

At baseline, participants with headache reported taking a range of symptomatic headache treatments including acetaminophen, ibuprofen, naproxen, and combination medications. Some also reported taking hydrocodone, tramadol, or combination formulations containing codeine.

More than one-third (37%) of the participants were assessed as overusing symptomatic pain medications, and 15 of these met the criteria for overuse of opioids or combination medications. Researchers noted that the mean Headache Impact Test-6 scores were significantly higher in those who were overusing medications, compared with those who weren’t.

The most common headache phenotype was migraine (52%), followed by tension-type headache (22%), probable migraine (16%), and probable tension-type headache (4%), with 7% unclassified.

Patients with headache also experienced associated symptoms such as photophobia, phonophobia, nausea, vomiting, visual loss or obscurations, diplopia, and dizziness.

The study was funded by the National Eye Institute. No conflicts of interest were declared.

 

Headache in idiopathic intracranial hypertension appears to be clinically independent of raised intracranial pressure and may require a different treatment approach than simply lowering intracranial pressure, say the authors of a study published online July 28 in Headache.

The researchers looked at data from 165 patients with untreated idiopathic intracranial hypertension (IIH) and mild vision loss, who were randomized to weight loss plus acetazolamide or placebo as part of the Idiopathic Intracranial Hypertension Treatment Trial.

In the 139 patients who had headaches at baseline, the researchers saw no significant correlation between lumbar puncture opening pressure – which was measured at baseline and 6 months – and Headache Impact Test-6 scores, or with the presence or absence of headache (Headache. 2017 Jul 28. doi: 10.1111/head.13153).

“Both providers and patients often perceive the headache of IIH as being directly linked to CSF [cerebrospinal fluid] pressure elevation, and they anticipate that lowering CSF pressure will improve headache control,” Deborah I. Friedman, MD, of the University of Texas, Dallas, and her coauthors wrote. “Our findings provide the first class I evidence that CSF pressure and headaches are clinically independent features of IIH.”

The study also failed to show any significant difference in headache outcomes between the acetazolamide and placebo groups at 6 months, although headaches in both groups improved overall during the course of the study.

“A substantial proportion of participants had severe headaches at 6 months, stressing the importance of incorporating other headache treatments,” the authors wrote. “These data support the view that additional treatments beyond those used to lower intracranial pressure are needed to treat the headaches associated with IIH.”

At baseline, participants with headache reported taking a range of symptomatic headache treatments including acetaminophen, ibuprofen, naproxen, and combination medications. Some also reported taking hydrocodone, tramadol, or combination formulations containing codeine.

More than one-third (37%) of the participants were assessed as overusing symptomatic pain medications, and 15 of these met the criteria for overuse of opioids or combination medications. Researchers noted that the mean Headache Impact Test-6 scores were significantly higher in those who were overusing medications, compared with those who weren’t.

The most common headache phenotype was migraine (52%), followed by tension-type headache (22%), probable migraine (16%), and probable tension-type headache (4%), with 7% unclassified.

Patients with headache also experienced associated symptoms such as photophobia, phonophobia, nausea, vomiting, visual loss or obscurations, diplopia, and dizziness.

The study was funded by the National Eye Institute. No conflicts of interest were declared.

 

Headache in idiopathic intracranial hypertension appears to be clinically independent of raised intracranial pressure and may require a different treatment approach than simply lowering intracranial pressure, say the authors of a study published online July 28 in Headache.

The researchers looked at data from 165 patients with untreated idiopathic intracranial hypertension (IIH) and mild vision loss, who were randomized to weight loss plus acetazolamide or placebo as part of the Idiopathic Intracranial Hypertension Treatment Trial.

In the 139 patients who had headaches at baseline, the researchers saw no significant correlation between lumbar puncture opening pressure – which was measured at baseline and 6 months – and Headache Impact Test-6 scores, or with the presence or absence of headache (Headache. 2017 Jul 28. doi: 10.1111/head.13153).

“Both providers and patients often perceive the headache of IIH as being directly linked to CSF [cerebrospinal fluid] pressure elevation, and they anticipate that lowering CSF pressure will improve headache control,” Deborah I. Friedman, MD, of the University of Texas, Dallas, and her coauthors wrote. “Our findings provide the first class I evidence that CSF pressure and headaches are clinically independent features of IIH.”

The study also failed to show any significant difference in headache outcomes between the acetazolamide and placebo groups at 6 months, although headaches in both groups improved overall during the course of the study.

“A substantial proportion of participants had severe headaches at 6 months, stressing the importance of incorporating other headache treatments,” the authors wrote. “These data support the view that additional treatments beyond those used to lower intracranial pressure are needed to treat the headaches associated with IIH.”

At baseline, participants with headache reported taking a range of symptomatic headache treatments including acetaminophen, ibuprofen, naproxen, and combination medications. Some also reported taking hydrocodone, tramadol, or combination formulations containing codeine.

More than one-third (37%) of the participants were assessed as overusing symptomatic pain medications, and 15 of these met the criteria for overuse of opioids or combination medications. Researchers noted that the mean Headache Impact Test-6 scores were significantly higher in those who were overusing medications, compared with those who weren’t.

The most common headache phenotype was migraine (52%), followed by tension-type headache (22%), probable migraine (16%), and probable tension-type headache (4%), with 7% unclassified.

Patients with headache also experienced associated symptoms such as photophobia, phonophobia, nausea, vomiting, visual loss or obscurations, diplopia, and dizziness.

The study was funded by the National Eye Institute. No conflicts of interest were declared.