Idiopathic Intracranial Hypertension

Headache Description

What are the pain characteristics of the headache?

What is the location of the headache?

When did the headache start?

What is the frequency of the headache?

Are there aggravating factors?

Are there relieving factors?

Prior to headache development, does the patient carry a diagnosis of a specific headache disorder?

Review of Systems

Pulsatile tinnitus (whoosing 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

Analgesics tried, both prescribed and over the counter (name, dosing, frequency, efficacy)?

Evaluation and Work-Up

Evaluated by optometrist/ophthalmologist/neurologist before? Signs of elevated intracranial pressure identified on exam? (papilledema, abducens nerve palsies, visual field defect)

Prior brain imaging performed? Preferred studies: MRI brain w/ and w/o + MRV or CTV with contrast (Evaluate for supportive findings of IIH, rule out structural causes and rule out cerebral venous sinus thrombosis)

Prior lumbar puncture? Performed at bedside or fluoroscopy? Positioning? (lateral decubitus vs sitting upright, prone), Opening and closing pressures?

The patient meets the criteria for idiopathic intracranial hypertension