Idiopathic Intracranial Hypertension

Also called “Pseudotumor Cerebri,” primarily affects obese women of childbearing age.  Very rare (incidence <1:100,000), but more common among high risk women (1:5,000).  Total numbers may increase given the obesity epidemic.  Permanent visual loss occurs in up to 25%.  Treatments include weight loss, various diuretics, and a myriad of surgical procedures, all with mixed results.

The headache is often retro-orbital, exacerbated by eye movement, commonly throbbing (but maybe not).  Key findings: papilledema (occasionally unilateral) or objective visual deficits on physical exam.  Neuroimaging is normal, LP gives a high opening pressure with normal CSF.

Diagnosis is often missed or delayed.  If a patient fits the demographic, and there’s no other good explanation for a chronic headache, even if the exam is normal consider a neurology referral.

See posting Chronic Headache.