Intracranial pressure directly predicts headache morbidity in idiopathic intracranial hypertension

Susan Mollan, Benjamin Wakerley, Zerin Alimajstorovic, James Mitchell, Ryan Ottridge, Andreas Yiangou, Mark Thaller, A Gupta, Olivia Grech, Gareth Lavery, K Brock, Alex Sinclair

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Objective: Headache is the predominant disabler in idiopathic intracranial hypertension (IIH). The aim was to characterise headache and investigate the association with intracranial pressure. Methods: IIH:WT was a randomised controlled parallel group multicentre trial in the United Kingdom investigating weight management methods in IIH. Participants with active IIH (evidenced by papilloedema) and a body mass index (BMI) ≥35 kg/m 2 were recruited. At baseline, 12 months and 24 months headache characteristics and quality of life outcome measures were collected and lumbar puncture measurements were performed. Results: Sixty-six women with active IIH were included with a mean age of 32.0 years (SD ± 7.8), and mean body mass index of 43.9 ± 7.0 kg/m 2. The headache phenotype was migraine-like in 90%. Headache severity correlated with ICP at baseline (r = 0.285; p = 0.024); change in headache severity and monthly headache days correlated with change in ICP at 12 months (r = 0.454, p = 0.001 and r = 0.419, p = 0.002 respectively). Cutaneous allodynia was significantly correlated with ICP at 12 months. (r = 0.479, p < 0.001). Boot strap analysis noted a positive association between ICP at 12 and 24 months and enabled prediction of both change in headache severity and monthly headache days. ICP was associated with significant improvements in quality of life (SF-36). Conclusions: We demonstrate a positive relationship between ICP and headache and cutaneous allodynia, which has not been previously reported in IIH. Those with the greatest reduction in ICP over 12 months had the greatest reduction in headache frequency and severity; this was associated with improvement of quality of life measures. Trial registration: This work provides Class IIa evidence of the association of raised intracranial pressure and headache. number, NCT02124486.

Original languageEnglish
Article number118
Number of pages9
JournalThe Journal of Headache and Pain
Issue number1
Publication statusPublished - 7 Oct 2021

Bibliographical note

Funding Information:
This study was supported by the National Institute of Health Research UK (NIHR-CS-011-028), the Medical Research Council UK (MR/K015184/1).

Publisher Copyright:
© 2021, The Author(s).


  • Allodynia
  • Calcitonin gene related peptide
  • Idiopathic intracranial hypertension
  • Intracranial pressure
  • Migraine

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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