Birmingham Neuro-Ophthalmology Unit, University Hospitals Birmingham, Birmingham, UK.
University of Birmingham, Metabolic Neurology, Institute of Metabolism and Systems Research, Birmingham, UK.
J Headache Pain. 2021 Oct 7;22(1):118. doi: 10.1186/s10194-021-01321-8.
Headache is the predominant disabler in idiopathic intracranial hypertension (IIH). The aim was to characterise headache and investigate the association with intracranial pressure.
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 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.
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. 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).
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.
This work provides Class IIa evidence of the association of raised intracranial pressure and headache. ClinicalTrials.gov number, NCT02124486 .
头痛是特发性颅内高压症（IIH）的主要致残因素。本研究旨在描述头痛特征，并探讨其与颅内压的关系。
IIH:WT 是一项在英国进行的随机对照平行分组多中心试验，旨在研究 IIH 的体重管理方法。纳入标准为：有活动期 IIH（依据乳头水肿证实）且体重指数（BMI）≥35kg/m²的患者。基线、12 个月和 24 个月时收集头痛特征和生活质量评估结果，同时行腰椎穿刺测量颅内压。
共纳入 66 例女性活动期 IIH 患者，平均年龄为 32.0 岁（标准差±7.8 岁），平均 BMI 为 43.9±7.0kg/m²。90%的头痛表现为偏头痛样。头痛严重程度与基线时的颅内压相关（r=0.285；p=0.024）；头痛严重程度变化和每月头痛天数与 12 个月时颅内压变化相关（r=0.454，p=0.001 和 r=0.419，p=0.002）。皮肤感觉过敏与 12 个月时的颅内压显著相关（r=0.479，p<0.001）。Bootstrap 分析提示，12 个月时颅内压与 24 个月时颅内压呈正相关，可预测头痛严重程度变化和每月头痛天数。颅内压与生活质量（SF-36）的显著改善相关。
本研究表明，颅内压与头痛和皮肤感觉过敏呈正相关，这在 IIH 中尚未见报道。12 个月内颅内压下降幅度最大的患者头痛频率和严重程度下降幅度最大，生活质量评分也得到改善。
本研究提供了 IIH 中颅内压升高与头痛相关的 IIa 类证据。临床试验注册号：NCT02124486。
