Table of contents
Idiopathic intracranial hypertension
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of idiopathic intracranial hypertension are prepared by our editorial team based on guidelines from the Association of British Neurologists (ABN/RCOphth/BASH/SBNS 2018).
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Diagnostic investigations
History and physical examination: as per ABN/BASH/RCOphth/SBNS 2018 guidelines, elicit a careful history to exclude any possible secondary causes of raised intracranial hypertension, recognizing that the causal link with idiopathic intracranial hypertension and a number of diseases and medications is not clear.
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Laboratory tests
Diagnostic imaging
Assessment of comorbidities
Diagnostic procedures
Medical management
General principles: as per ABN/BASH/RCOphth/SBNS 2018 guidelines, consider providing a multidisciplinary team approach including, ideally, an assessment by an experienced clinician with an interest in headache management.
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Acetazolamide
Topiramate
Non-opioid analgesics
Opioids
Migraine prophylaxis
Management of migraine attacks
Nonpharmacologic interventions
Lifestyle modifications: as per ABN/BASH/RCOphth/SBNS 2018 guidelines, provide lifestyle advice in all patients with headache disorders, as these can have considerable impact on the disease course.
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Weight loss
Therapeutic procedures
Greater occipital nerve block: as per ABN/BASH/RCOphth/SBNS 2018 guidelines, insufficient evidence to recommend greater occipital nerve blocks for the management of headaches in patients with newly diagnosed idiopathic intracranial hypertension.
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Therapeutic lumbar puncture
Neurovascular stenting
Surgical interventions
Optic nerve sheath fenestration: as per ABN/BASH/RCOphth/SBNS 2018 guidelines, perform surgery for the acute management to preserve vision if there is evidence of declining visual function.
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CSF diversion shunting
Specific circumstances
Pregnant patients: as per ABN/BASH/RCOphth/SBNS 2018 guidelines, insufficient evidence to support the use of acetazolamide during pregnancy. Recognize that manufacturers do not recommend its use. Discuss the risks and benefits regarding the necessity of acetazolamide treatment during pregnancy with the patient because of the possible risk of teratogenic effects.
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Patients with IIH without papilledema
Patients with CSF diversion shunts (evaluation)
Patients with CSF diversion shunts (management of headache)