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Acetazolamide improved vision in patients with high intracranial pressure
Major finding: After 6 months of treatment, the acetazolamide group had an average perimetric mean deviation of –2.10 dB, compared with –2.82 dB...
Headache in idiopathic intracranial hypertension appears to be clinically independent of raised intracranial pressure and may require a different treatment approach than simply lowering intracranial pressure, say the authors of a study published online July 28 in Headache.
The researchers looked at data from 165 patients with untreated idiopathic intracranial hypertension (IIH) and mild vision loss, who were randomized to weight loss plus acetazolamide or placebo as part of the Idiopathic Intracranial Hypertension Treatment Trial.
In the 139 patients who had headaches at baseline, the researchers saw no significant correlation between lumbar puncture opening pressure – which was measured at baseline and 6 months – and Headache Impact Test-6 scores, or with the presence or absence of headache (Headache. 2017 Jul 28. doi: 10.1111/head.13153).
Dr. Deborah Friedman
The study also failed to show any significant difference in headache outcomes between the acetazolamide and placebo groups at 6 months, although headaches in both groups improved overall during the course of the study.
“A substantial proportion of participants had severe headaches at 6 months, stressing the importance of incorporating other headache treatments,” the authors wrote. “These data support the view that additional treatments beyond those used to lower intracranial pressure are needed to treat the headaches associated with IIH.”
At baseline, participants with headache reported taking a range of symptomatic headache treatments including acetaminophen, ibuprofen, naproxen, and combination medications. Some also reported taking hydrocodone, tramadol, or combination formulations containing codeine.
More than one-third (37%) of the participants were assessed as overusing symptomatic pain medications, and 15 of these met the criteria for overuse of opioids or combination medications. Researchers noted that the mean Headache Impact Test-6 scores were significantly higher in those who were overusing medications, compared with those who weren’t.
The most common headache phenotype was migraine (52%), followed by tension-type headache (22%), probable migraine (16%), and probable tension-type headache (4%), with 7% unclassified.
Patients with headache also experienced associated symptoms such as photophobia, phonophobia, nausea, vomiting, visual loss or obscurations, diplopia, and dizziness.
The study was funded by the National Eye Institute. No conflicts of interest were declared.