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July 1, 2019

The Dilemma of Diagnosing Idiopathic Intracranial Hypertension Without Papilledema in Patients With Chronic Migraine

Author Affiliations
  • 1Department of Neurology, Duke University, Durham, North Carolina
JAMA Neurol. 2019;76(9):1001-1002. doi:10.1001/jamaneurol.2019.1696

Paralleling the global rise of obesity, idiopathic intracranial hypertension (IIH) incidence is dramatically rising.1 However, IIH is still defined as elevated intracranial pressure (ICP) with no distinguishable etiology. Moreover, controversy regarding pathogenesis continues; IIH can be misdiagnosed as migraine, which is a far more common disorder, resulting in delayed diagnosis and the potential for permanent neurologic deficits, including blindness. Prompt diagnosis, including fundoscopic examination, and management are critical. Multiple reports suggest the concurrence of chronic migraine and IIH, particularly IIH without papilledema (IIHWOP), is significant, and lumbar puncture (LP) should be performed in patients with refractory chronic migraine.2,3 However, this coexistence is actually rare,4 not clinically significant, and may lead to unnecessary invasive surgeries.

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