Advances in the understanding of headache in idiopathic intracranial hypertension

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Purpose of review

To review the most relevant developments in the understanding of headache in idiopathic intracranial hypertension (IIH).

Recent findings

The phenotype of the typical IIH headache is diverging from the historical thinking of a raised intracranial pressure headache, with the majority being classified as having migraine. A larger proportion of those with IIH have a past medical history of migraine, compared with the general population, highlighting the importance of re-examining those who have a change or escalation in their headache. The mechanisms underlying headache in IIH are not understood. Additionally, factors which confer a poor headache prognosis are not established. It is clear, however, that headache has a detrimental effect on all aspects of the patient's quality of life and is currently ranked highly as a research priority by IIH patients to better understand the pathophysiology of headache in IIH and identification of potential headache specific therapeutic agents.

Summary

Headache remains the predominate morbidity in the majority of those with 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.

Related collections

Most cited references 44

Record: found
Abstract: found
Article: not found

A six-item short-form survey for measuring headache impact: the HIT-6.

M Kosinski, M S Bayliss, J. Bjorner … (2003)

Migraine and other severe headaches can cause suffering and reduce functioning and productivity. Patients are the best source of information about such impact. To develop a new short form (HIT-6) for assessing the impact of headaches that has broad content coverage but is brief as well as reliable and valid enough to use in screening and monitoring patients in clinical research and practice. HIT-6 items were selected from an existing item pool of 54 items and from 35 items suggested by clinicians. Items were selected and modified based on content validity, item response theory (IRT) information functions, item internal consistency, distributions of scores, clinical validity, and linguistic analyses. The HIT-6 was evaluated in an Internet-based survey of headache sufferers (n = 1103) who were members of America Online (AOL). After 14 days, 540 participated in a follow-up survey. HIT-6 covers six content categories represented in widely used surveys of headache impact. Internal consistency, alternate forms, and test-retest reliability estimates of HIT-6 were 0.89, 0.90, and 0.80, respectively. Individual patient score confidence intervals (95%) of app. +/-5 were observed for 88% of all respondents. In tests of validity in discriminating across diagnostic and headache severity groups, relative validity (RV) coefficients of 0.82 and 1.00 were observed for HIT-6, in comparison with the Total Score. Patient-level classifications based in HIT-6 were accurate 88.7% of the time at the recommended cut-off score for a probability of migraine diagnosis. HIT-6 was responsive to self-reported changes in headache impact. The IRT model estimated for a 'pool' of items from widely used measures of headache impact was useful in constructing an efficient, reliable, and valid 'static' short form (HIT-6) for use in screening and monitoring patient outcomes.

0 comments Cited 316 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Idiopathic intracranial hypertension: consensus guidelines on management

Susan Mollan, Brendan Davies, Nick Silver … (2018)

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). Methods Between September 2015 and October 2017, a specialist interest group including neurology, neurosurgery, neuroradiology, ophthalmology, nursing, primary care doctors and patient representatives met. An initial UK survey of attitudes and practice in IIH was sent to a wide group of physicians and surgeons who investigate and manage IIH regularly. A comprehensive systematic literature review was performed to assemble the foundations of the statements. An international panel along with four national professional bodies, namely the Association of British Neurologists, British Association for the Study of Headache, the Society of British Neurological Surgeons and the Royal College of Ophthalmologists critically reviewed the statements. Results Over 20 questions were constructed: one based on the diagnostic principles for optimal investigation of papilloedema and 21 for the management of IIH. Three main principles were identified: (1) to treat the underlying disease; (2) to protect the vision; and (3) to minimise the headache morbidity. Statements presented provide insight to uncertainties in IIH where research opportunities exist. Conclusions In collaboration with many different specialists, professions and patient representatives, we have developed guidance statements for the investigation and management of adult IIH.

0 comments Cited 138 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions.

Keira Markey, Susan Mollan, Rigmor Jensen … (2016)

Idiopathic intracranial hypertension is a disorder characterised by raised intracranial pressure that predominantly affects young, obese women. Pathogenesis has not been fully elucidated, but several causal factors have been proposed. Symptoms can include headaches, visual loss, pulsatile tinnitus, and back and neck pain, but the clinical presentation is highly variable. Although few studies have been done to support evidence-based management, several recent advances have the potential to enhance understanding of the causes of the disease and to guide treatment decisions. Investigators of the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) reported beneficial effects of acetazolamide in patients with mild visual loss. Studies have also established weight loss as an effective disease-modifying treatment, and further clinical trials to investigate new treatments are underway. The incidence of idiopathic intracranial hypertension is expected to increase as rates of obesity increase; efforts to reduce diagnostic delays and identify new, effective approaches to treatment will be key to meeting the needs of a growing number of patients.

0 comments Cited 125 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): Curr Opin Neurol

Journal ID (iso-abbrev): Curr. Opin. Neurol

Journal ID (publisher-id): CONEU

Title: Current Opinion in Neurology

Publisher: Lippincott Williams & Wilkins

ISSN (Print): 1350-7540

ISSN (Electronic): 1473-6551

Publication date (Print): February 2019

Publication date (Electronic): 12 December 2018

Volume: 32

Issue: 1

Pages: 92-98

Affiliations

[a ]Birmingham Neuro-Ophthalmology, University Hospitals Birmingham, NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham

[b ]Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, Wellcome Foundation Building, Denmark Hill Campus, King's College London, London

[c ]Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston

[d ]Department of Neurology, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham

[e ]Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK

Author notes

Correspondence to Dr Alexandra J. Sinclair, Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK. E-mail: a.b.Sinclair@ 123456bham.ac.uk

Article

Publisher ID: WCO320119 Accession ID: 00016

DOI: 10.1097/WCO.0000000000000651

PMC ID: 6343949

PubMed ID: 30547900

SO-VID: 2d87f370-d40e-4f00-adaa-5293671ce8ef

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

History

Custom metadata

OPEN-ACCESS TRUE

Keywords: headache,idiopathic intracranial hypertension,medication overuse headache,migraine,raised intracranial pressure

Data availability:

Keywords: headache, idiopathic intracranial hypertension, medication overuse headache, migraine, raised intracranial pressure

Advances in the understanding of headache in idiopathic intracranial hypertension

Read this article at

Abstract

Purpose of review

Recent findings

Summary

Related collections

UCL Grand Challenges: Cultural Understanding

Most cited references 44

A six-item short-form survey for measuring headache impact: the HIT-6.

Idiopathic intracranial hypertension: consensus guidelines on management

Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions.

Author and article information

Journal

Affiliations

Author notes

Article

History

Categories

Custom metadata

Comments

Comment on this article

Similar content 245

Cited by 34

Most referenced authors 462