Susan P Mollan1, Olivia Grech2,3, Alexandra J Sinclair1,2,3,4. 1. Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, Birmingham, UK. 2. Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. 3. Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK. 4. Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK.
Abstract
OBJECTIVE: Headache is a near-universal sequela of idiopathic intracranial hypertension (IIH). The aim of this paper is to report current knowledge of headache in IIH and to identify therapeutic options. BACKGROUND: Disability in IIH is predominantly driven by headache; thus, headache management is an urgent and unmet clinical need. At present, there is currently no scientific evidence for the directed use of abortive or preventative headache therapy. METHODS: A detailed search of the scientific literature and narrative review was performed. RESULTS: Headache in IIH is driven by raised intracranial pressure (ICP) and reduction of ICP has been reported in some studies to reduce headache. Despite resolution of papilledema and normalization of raised ICP, a majority suffer persistent post-IIH headache. The lack of evidence-based management approaches leaves many untreated. Where clinicians attempt to manage IIH headache, they use off-label therapies to target the prevailing headache phenotype. A recent prospective open-label study demonstrated the effective use of a calcitonin gene-related peptide monoclonal antibody therapy in IIH for persistent post-IIH headache. CONCLUSIONS: There is overwhelming evidence of the headache burden in IIH. Studies are required to investigate the biological foundations of headache related to ICP and to develop treatments specifically directed to manage headache in IIH.
OBJECTIVE: Headache is a near-universal sequela of idiopathic intracranial hypertension (IIH). The aim of this paper is to report current knowledge of headache in IIH and to identify therapeutic options. BACKGROUND: Disability in IIH is predominantly driven by headache; thus, headache management is an urgent and unmet clinical need. At present, there is currently no scientific evidence for the directed use of abortive or preventative headache therapy. METHODS: A detailed search of the scientific literature and narrative review was performed. RESULTS: Headache in IIH is driven by raised intracranial pressure (ICP) and reduction of ICP has been reported in some studies to reduce headache. Despite resolution of papilledema and normalization of raised ICP, a majority suffer persistent post-IIH headache. The lack of evidence-based management approaches leaves many untreated. Where clinicians attempt to manage IIH headache, they use off-label therapies to target the prevailing headache phenotype. A recent prospective open-label study demonstrated the effective use of a calcitonin gene-related peptide monoclonal antibody therapy in IIH for persistent post-IIH headache. CONCLUSIONS: There is overwhelming evidence of the headache burden in IIH. Studies are required to investigate the biological foundations of headache related to ICP and to develop treatments specifically directed to manage headache in IIH.
Authors: Mark Thaller; Victoria Homer; Yousef Hyder; Andreas Yiangou; Anthony Liczkowski; Anthony W Fong; Jasvir Virdee; Rachel Piccus; Marianne Roque; Susan P Mollan; Alexandra J Sinclair Journal: J Neurol Date: 2022-10-15 Impact factor: 6.682
Authors: Connar S J Westgate; Keira Markey; James L Mitchell; Andreas Yiangou; Rishi Singhal; Paul Stewart; Jeremy W Tomlinson; Gareth G Lavery; Susan P Mollan; Alexandra J Sinclair Journal: Eur J Endocrinol Date: 2022-07-04 Impact factor: 6.558