Department of Clinical Neuroscience, Headache Unit, C. Besta Neurological Institute and Foundation, Via Celoria, 11 20133 Milan, Italy.
Neurol Sci. 2013 May;34 Suppl 1:S147-9. doi: 10.1007/s10072-013-1388-7.
Headache is a key symptom of idiopathic intracranial hypertension (IIH). Operational diagnostic criteria for "Headache attributed to IIH" are included in the international classification of headache disorders, the ICHD-2. The association of IIH with obesity was established by several reports. We investigate the prevalence of headache and its main clinical features in a clinical sample of IIH patients. The possible correlations between the presence of headache and body mass index (BMI) and intracranial pressure (ICP) levels were studied in a consecutive clinical series of patients, in whom diagnosis of IIH was confirmed by exclusion of secondary forms and by the evidence of increased ICP. Differences for age, BMI, and ICP between patients with and without headache and between males and females were assessed with Mann-Whitney U test. Spearman's correlation analysis was used to assess relationships between age, BMI, and ICP. P value < 0.05 was used to set statistical significance. 40 patients entered the study (9 males, 31 females; mean age 39, 8 years, SD 13.2). Headache was reported by 75 % patients. Those characteristics which are included in the present international diagnostic criteria for "Headache attributed to IIH" were reported by a remarkable proportion of the studied patients, but not by all. On the other hand, some headache features usually attributed to migraine forms, and which are not among the required criteria were present in some patients: pulsating quality and unilateral distribution of pain in around 20 %, and migrainous associated symptoms in more than 40 % of the sample. According to statistical analyses, no differences were found for age, BMI, and ICP between patients with and without headache. Our results confirmed the strong association between headache and IIH. Although no significant correlations between some of the key features of IIH were found in this study, we suggest that further studies on larger series--possibly with a longitudinal evaluation--are needed, to help clinicians in categorizing different subgroups among IIH patients as well as in identifying the main factors influencing the prognosis of this disorder.
头痛是特发性颅内高压症（IIH）的一个主要症状。国际头痛疾病分类（ICHD-2）包含了将头痛归因于 IIH 的操作性诊断标准。几项报告证实了 IIH 与肥胖之间的关联。我们调查了 IIH 患者临床样本中头痛的患病率及其主要临床特征。在连续的 IIH 患者临床系列中，通过排除继发性疾病和证据表明颅内压（ICP）升高来证实 IIH 的诊断，研究了头痛与体重指数（BMI）和 ICP 水平之间存在的相关性。采用 Mann-Whitney U 检验评估头痛患者和无头痛患者、男性和女性之间年龄、BMI 和 ICP 的差异。采用 Spearman 相关分析评估年龄、BMI 和 ICP 之间的关系。P 值<0.05 用于确定统计学意义。40 名患者入组研究（9 名男性，31 名女性；平均年龄 39.8 岁，标准差 13.2）。75%的患者报告有头痛。所研究患者中相当大比例的患者报告了符合目前国际“归因于 IIH 的头痛”诊断标准的特征，但并非所有患者都报告了这些特征。另一方面，一些通常归因于偏头痛的头痛特征并不在所需标准之列，但在一些患者中存在：疼痛呈搏动性和单侧分布，约占 20%，偏头痛相关症状超过 40%的样本。根据统计分析，头痛患者与无头痛患者之间在年龄、BMI 和 ICP 方面无差异。我们的研究结果证实了头痛与 IIH 之间的强烈关联。尽管本研究未发现 IIH 的某些关键特征之间存在显著相关性，但我们建议需要对更大系列的患者进行进一步研究，包括可能的纵向评估，以帮助临床医生对 IIH 患者进行不同亚组的分类，以及确定影响该疾病预后的主要因素。
