Idiopathic Intracranial Hypertension

Overview

IIH is a condition of elevated intracranial pressure without an identifiable cause (no tumor, infection, or obstruction). It primarily affects women of childbearing age who are overweight. The increased pressure can damage the optic nerve (papilledema) and cause permanent vision loss if untreated.

Symptoms

• Daily headache (often severe, worse in morning)
• Visual disturbances (blurred vision, double vision, transient visual obscurations)
• Papilledema (swollen optic disc)
• Pulsatile tinnitus
• Nausea/vomiting

Causes

• Unknown — likely impaired CSF absorption or increased CSF production
• Associated with obesity, certain medications (tetracyclines, vitamin A, lithium), hormonal factors

Risk factors

• Women of childbearing age
• Obesity
• Recent weight gain
• Certain medications (tetracyclines, vitamin A, lithium)
• Polycystic ovary syndrome

Diagnosis

Lumbar puncture (elevated opening pressure >250 mmH2O)|MRI/MRV (exclude venous sinus thrombosis, mass lesion)|Ophthalmological exam (papilledema)

Treatment & management

Weight loss (primary treatment — even 5–10% weight loss can resolve IIH)|Acetazolamide (first-line medication)|Topiramate (alternative)|Repeated lumbar punctures for refractory cases|Surgical: optic nerve sheath fenestration or CSF shunt for vision-threatening cases

Management is individualized and discussed with benefits, limitations, and follow-up.

Prevention & self-care

Weight management|Avoid medications that raise ICP (tetracyclines, vitamin A excess)|Regular eye exams to monitor papilledema

When to seek medical attention

• Sudden vision loss
• Worsening visual field defects
• Severe headache unresponsive to treatment
• New neurological symptoms

Frequently asked questions