Idiopathic Intracranial Hypertension

Headache Description

Onset of symptoms

Pain characteristics

Headache location

Frequency

Aggravating factors

Relieving factors

Prior to headache development, the patient carried a diagnosis of a specific headache disorder

Review of Systems

Pulsatile tinnitus (whooshing sound indicating turbulent blood flow across stenotic venous sinus)

Headache worse when lying down and/or waking from sleep (sign of increased intracranial pressure)

Transient visual obscurations, blurry vision/transient vision loss spontaneously or with Valsalva maneuvers (transient optic nerve head ischemia)

Double vision resolving with either eye closed and worse with far vision (abducens nerve palsy secondary to elevated intracranial pressure)

Recent weight change

Use of growth hormone, tetracycline or vitamin-A containing products (associated with IIH)

Snoring/choking/gasping at night, excessive daytime sleepiness (obstructive sleep apnea screen)

Associated condition present (Turner Syndrome, Down syndrome, polycystic ovarian syndrome, Addison Disease, hypoparathyroidism, obstructive sleep apnea)

Headache Treatment

Over the counter and prescribed analgesics tried (name, dosing, frequency, efficacy)

Diagnostic Evaluation

The patient meets criteria for idiopathic intracranial hypertension.

Blood tests

Specialist evaluation (optometrist/ophthalmologist/neurologist) performed and signs of elevated intracranial pressure identified on exam (papilledema, abducens nerve palsies, visual field defect)

Brain imaging performed (Preferred studies: MRI brain with and without contrast and MR-venogram)

Lumbar puncture (Performed at bedside or fluoroscopy, positioning (lateral decubitus vs sitting upright, prone), opening and closing pressures))

Other diagnostics