Skip to main content

Advertisement

SpringerLink
Log in

Overlap and Differences in Migraine and Idiopathic Intracranial Hypertension

  • Chronic Daily Headache (S-J Wang and S-P Chen, Section Editors)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Migraine and idiopathic intracranial hypertension (IIH) are increasingly encountered but remain enigmatic. This review compares the similarities and differences of the diagnostic criteria, pathophysiology, and risk factors for chronic migraine and IIH.

Recent Findings

While migraine and IIH are distinct diseases, both conditions are frequently found concurrently and may share a link. Increased intracranial pressure (ICP) in those with or without pre-existing migraine may present with migraine-like headaches and contribute to migraine chronification. Increased intracranial pressure may be a coincidental occurrence in patients with migraine and normalization of pressure does not always translate to headache improvement. Limited information is available regarding the standard of treatment for patients with chronic migraine and IIH without papilledema.

Summary

There continues to be controversy over the normal range of cerebral spinal fluid (CSF) values. Recognizing the concurrence of both conditions advances our understanding of headache pathology and demonstrates a striking need for more research.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Munakata J, Hazard E, Serrano D, Klingman D, Rupnow MFT, Tierce J, et al. Economic burden of transformed migraine: results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache: The Journal of Head and Face Pain. 2009;49(4):498–508.

  2. •• Mollan SP, Grech O, Sinclair AJ. Headache attributed to idiopathic intracranial hypertension and persistent post-idiopathic intracranial hypertension headache: a narrative review. Headache. 2021;61(6):808–16. A comprehensive review of persistent post-IIH headache.

  3. Blanch RJ, Vasseneix C, Liczkowski A, Yiangou A, Aojula A, Micieli JA, et al. Differing presenting features of idiopathic intracranial hypertension in the UK and US. Eye (Lond). 2019;33(6):1014–9.

    Article  PubMed  CAS  Google Scholar 

  4. Hoffmann J, Mollan SP, Paemeleire K, Lampl C, Jensen RH, Sinclair AJ. European Headache Federation guideline on idiopathic intracranial hypertension. J Headache Pain. 2018;19(1):93.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Zur D, Naftaliev E, Kesler A. Evidence of multidomain mild cognitive impairment in idiopathic intracranial hypertension. J Neuroophthalmol. 2015;35(1):26–30.

    Article  PubMed  Google Scholar 

  6. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211.

  7. Chalmer MA, Hansen TF, Lebedeva ER, Dodick DW, Lipton RB, Olesen J. Proposed new diagnostic criteria for chronic migraine. Cephalalgia. 2020;40(4):399–406.

    Article  PubMed  Google Scholar 

  8. Digre KB. Idiopathic intracranial hypertension headache. Curr Pain Headache Rep. 2002;6(3):217–25.

    Article  PubMed  Google Scholar 

  9. Funnell JP, Craven CL, D’Antona L, Thompson SD, Chari A, Thorne L, et al. Intracranial pressure in patients with papilloedema. Acta Neurol Scand. 2018;138(2):137–42.

    Article  PubMed  CAS  Google Scholar 

  10. Digre KB, Nakamoto BK, Warner JEA, Langeberg WJ, Baggaley SK, Katz BJ. A comparison of idiopathic intracranial hypertension with and without papilledema. Headache. 2009;49(2):185–93.

  11. Digre KB, Nakamoto BK, Warner JE, Langeberg WJ, Baggaley SK, Katz BJ. A comparison of idiopathic intracranial hypertension with and without papilledema. Headache. 2009;49(2):185–93.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Wang SJ, Silberstein SD, Patterson S, Young WB. Idiopathic intracranial hypertension without papilledema: a case-control study in a headache center. Neurology. 1998;51(1):245–9.

    Article  PubMed  CAS  Google Scholar 

  13. •• Favoni V, Pierangeli G, Toni F, Cirillo L, La Morgia C, Abu-Rumeileh S, et al. Idiopathic intracranial hypertension without papilledema (IIHWOP) in chronic refractory headache. Front Neurol. 2018;9:503. (Highlights the prevalence of IIHWOP.)

    Article  PubMed  PubMed Central  Google Scholar 

  14. Corbett JJ, Mehta MP. Cerebrospinal fluid pressure in normal obese subjects and patients with pseudotumor cerebri. Neurology. 1983;33(10):1386-.

  15. Whiteley W, Al-Shahi R, Warlow CP, Zeidler M, Lueck CJ. CSF opening pressure: reference interval and the effect of body mass index. Neurology. 2006;67(9):1690–1.

    Article  PubMed  CAS  Google Scholar 

  16. • Mollan SP, Chong YJ, Grech O, Sinclair AJ, Wakerley BR. Current perspectives on idiopathic intracranial hypertension without papilloedema. Life. 2021;11(6):472. ()

    Article  PubMed  PubMed Central  Google Scholar 

  17. •• Friedman DI, Quiros PA, Subramanian PS, Mejico LJ, Gao S, McDermott M, et al. Headache in idiopathic intracranial hypertension: findings from the idiopathic intracranial hypertension treatment trial. Headache. 2017;57(8):1195–205. ()

    Article  PubMed  PubMed Central  Google Scholar 

  18. •• Adderley NJ, Subramanian A, Perrins M, Nirantharakumar K, Mollan SP, Sinclair AJ. Headache, opiate use, and prescribing trends in women with idiopathic intracranial hypertension: a population-based matched cohort study. Neurology. 2022;99(18):e1968–78. ()

    Article  PubMed  PubMed Central  Google Scholar 

  19. Friedman DI. Headaches in idiopathic intracranial hypertension. J Neuroophthalmol. 2019;39(1):82–93.

    Article  PubMed  Google Scholar 

  20. De Simone R, Marano E, Bilo L, Briganti F, Esposito M, Ripa P, et al. Idiopathic intracranial hypertension without headache. Cephalalgia. 2006;26(8):1020–1.

    Article  PubMed  Google Scholar 

  21. Sina F, Razmeh S, Habibzadeh N, Zavari A, Nabovvati M. Migraine headache in patients with idiopathic intracranial hypertension. Neurol Int. 2017;9(3):7280.

    Article  PubMed  PubMed Central  Google Scholar 

  22. D DA, Curone M, Ciasca P, Cammarata G, Melzi L, Bussone G, et al. Headache prevalence and clinical features in patients with idiopathic intracranial hypertension (IIH). Neurol Sci. 2013;34 Suppl 1:S147–9.

  23. Onder H, Ulusoy EK, Aslanyavrusu M, Akturk T, Arslan G, Akkurt I, et al. The prevalence of papilledema in patients with migraine: a crucial cooccurrence of migraine and idiopathic intracranial hypertension. Neurol Sci. 2020;41(9):2613–20.

    Article  PubMed  Google Scholar 

  24. De Simone R, Ranieri A, Montella S, Cappabianca P, Quarantelli M, Esposito F, et al. Intracranial pressure in unresponsive chronic migraine. J Neurol. 2014;261(7):1365–73.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Vieira DS, Masruha MR, Gonçalves AL, Zukerman E, Senne Soares CA, Naffah-Mazzacoratti Mda G, et al. Idiopathic intracranial hypertension with and without papilloedema in a consecutive series of patients with chronic migraine. Cephalalgia. 2008;28(6):609–13.

    Article  PubMed  CAS  Google Scholar 

  26. Migraine AM. N Engl J Med. 2020;383(19):1866–76.

    Article  Google Scholar 

  27. Goadsby PJ, Holland PR. An update: pathophysiology of migraine. Neurol Clin. 2019;37(4):651–71.

    Article  PubMed  Google Scholar 

  28. Iyengar S, Johnson KW, Ossipov MH, Aurora SK. CGRP and the trigeminal system in migraine. Headache. 2019;59(5):659–81.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Mollan SP, Ali F, Hassan-Smith G, Botfield H, Friedman DI, Sinclair AJ. Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management. J Neurol Neurosurg Psychiatry. 2016;87(9):982–92.

    Article  PubMed  Google Scholar 

  30. Markey KA, Uldall M, Botfield H, Cato LD, Miah MA, Hassan-Smith G, et al. Idiopathic intracranial hypertension, hormones, and 11beta-hydroxysteroid dehydrogenases. J Pain Res. 2016;9:223–32.

    PubMed  PubMed Central  CAS  Google Scholar 

  31. • Wichmann TO, Damkier HH, Pedersen M. A brief overview of the cerebrospinal fluid system and its implications for brain and spinal cord diseases. Front Hum Neurosci. 2021;15: 737217. (An overview of CSF dynamics.)

    Article  PubMed  CAS  Google Scholar 

  32. Lenck S, Radovanovic I, Nicholson P, Hodaie M, Krings T, Mendes-Pereira V. Idiopathic intracranial hypertension: the veno glymphatic connections. Neurology. 2018;91(11):515–22.

    Article  PubMed  Google Scholar 

  33. Mondejar V, Patsalides A. The Role of arachnoid granulations and the glymphatic system in the pathophysiology of idiopathic intracranial hypertension. Curr Neurol Neurosci Rep. 2020;20(7):20.

    Article  PubMed  Google Scholar 

  34. Leishangthem L, SirDeshpande P, Dua D, Satti SR. Dural venous sinus stenting for idiopathic intracranial hypertension: an updated review. J Neuroradiol. 2019;46(2):148–54.

    Article  PubMed  Google Scholar 

  35. De Simone R, Ranieri A, Sansone M, Marano E, Russo CV, Sacca F, et al. Dural sinus collapsibility, idiopathic intracranial hypertension, and the pathogenesis of chronic migraine. Neurol Sci. 2019;40(Suppl 1):59–70.

    Article  PubMed  Google Scholar 

  36. Friedman DI, Rausch EA. Headache diagnoses in patients with treated idiopathic intracranial hypertension. Neurology. 2002;58(10):1551–3.

    Article  PubMed  Google Scholar 

  37. Togha M, Shirbache K, Rahmanzadeh R, Ghorbani Z, Yari Z, Refaeian F, et al. Prevalence of new-onset migraine in patients with idiopathic intracranial hypertension in comparison to the general population. Iran J Neurol. 2018;17(4):161–6.

    PubMed  PubMed Central  Google Scholar 

  38. Farhadi Z, Alidoost S, Behzadifar M, Mohammadibakhsh R, Khodadadi N, Sepehrian R, et al. The prevalence of migraine in Iran: a systematic review and meta-analysis. Iran Red Crescent Med J. 2016;18(10): e40061.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Yri HM, Ronnback C, Wegener M, Hamann S, Jensen RH. The course of headache in idiopathic intracranial hypertension: a 12-month prospective follow-up study. Eur J Neurol. 2014;21(12):1458–64.

    Article  PubMed  CAS  Google Scholar 

  40. Smith SV, Friedman DI. The idiopathic intracranial hypertension treatment trial: a review of the outcomes. Headache. 2017;57(8):1303–10.

    Article  PubMed  Google Scholar 

  41. • Mollan SP, Wakerley BR, Alimajstorovic Z, Mitchell J, Ottridge R, Yiangou A, et al. Intracranial pressure directly predicts headache morbidity in idiopathic intracranial hypertension. J Headache Pain. 2021;22(1):118. ()

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  42. van Alphen HA. Migraine, a result of increased CSF pressure: a new pathophysiological concept (preliminary report). Neurosurg Rev. 1986;9(1–2):121–4.

    Article  PubMed  Google Scholar 

  43. Mathew NT, Ravishankar K, Sanin LC. Coexistence of migraine and idiopathic intracranial hypertension without papilledema. Neurology. 1996;46(5):1226–30.

    Article  PubMed  CAS  Google Scholar 

  44. De Simone R, Ranieri A. The role of intracranial hypertension in the chronification of migraine. Neurol Sci. 2015;36(Suppl 1):23–8.

    Article  PubMed  Google Scholar 

  45. Kelly LP, Saindane AM, Bruce BB, Ridha MA, Riggeal BD, Newman NJ, et al. Does bilateral transverse cerebral venous sinus stenosis exist in patients without increased intracranial pressure? Clin Neurol Neurosurg. 2013;115(8):1215–9.

    Article  PubMed  Google Scholar 

  46. Wall M. The headache profile of idiopathic intracranial hypertension. Cephalalgia. 1990;10(6):331–5.

    Article  PubMed  CAS  Google Scholar 

  47. Wall M, George D. Idiopathic intracranial hypertension. A prospective study of 50 patients. Brain. 1991;114 ( Pt 1A):155–80.

  48. Giuseffi V, Wall M, Siegel PZ, Rojas PB. Symptoms and disease associations in idiopathic intracranial hypertension (pseudotumor cerebri): a case-control study. Neurology. 1991;41(2(Pt 1)):239–44.

  49. Vetvik KG, MacGregor EA. Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. Lancet Neurol. 2017;16(1):76–87.

    Article  PubMed  CAS  Google Scholar 

  50. Bruce BB, Kedar S, Van Stavern GP, Monaghan D, Acierno MD, Braswell RA, et al. Idiopathic intracranial hypertension in men. Neurology. 2009;72(4):304–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  51. Sacco S, Ricci S, Degan D, Carolei A. Migraine in women: the role of hormones and their impact on vascular diseases. J Headache Pain. 2012;13(3):177–89.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  52. van Oosterhout WPJ, Schoonman GG, van Zwet EW, Dekkers OM, Terwindt GM, MaassenVanDenBrink A, et al. Female sex hormones in men with migraine. Neurology. 2018;91(4):e374–81.

    PubMed  Google Scholar 

  53. • Ailani J. Updates on management of headache in women and transgender women. Curr Opin Neurol. 2021;34(3):339–43. ()

    Article  PubMed  Google Scholar 

  54. • Thaller M, Wakerley BR, Abbott S, Tahrani AA, Mollan SP, Sinclair AJ. Managing idiopathic intracranial hypertension in pregnancy: practical advice. Pract Neurol. 2022;22(4):295–300. ()

    Article  PubMed  PubMed Central  Google Scholar 

  55. • Park DSJ, Park JSY, Sharma S, Sharma RA. Idiopathic intracranial hypertension in pregnancy. J Obstet Gynaecol Can. 2021;43(11):1292–5. ()

    Article  PubMed  Google Scholar 

  56. O’Reilly MW, Westgate CS, Hornby C, Botfield H, Taylor AE, Markey K, et al. A unique androgen excess signature in idiopathic intracranial hypertension is linked to cerebrospinal fluid dynamics. JCI Insight. 2019;4(6). Study evaluating androgen levels in women with IIH.

  57. • Mollan SP, Tahrani AA, Sinclair AJ. The potentially modifiable risk factor in idiopathic intracranial hypertension: body weight. Neurol Clin Pract. 2021;11(4):e504–7. ()

    Article  PubMed  PubMed Central  Google Scholar 

  58. Shields LBE, Seifert T, Shelton BJ, Plato BM. Testosterone levels in men with chronic migraine. Neurol Int. 2019;11(2):8079.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  59. Hornby C, Mollan SP, Botfield H, O’Reilly MW, Sinclair AJ. Metabolic concepts in idiopathic intracranial hypertension and their potential for therapeutic intervention. J Neuroophthalmol. 2018;38(4):522–30.

    Article  PubMed  PubMed Central  Google Scholar 

  60. May A, Schulte LH. Chronic migraine: risk factors, mechanisms and treatment. Nat Rev Neurol. 2016;12(8):455–64.

    Article  PubMed  CAS  Google Scholar 

  61. Daniels AB, Liu GT, Volpe NJ, Galetta SL, Moster ML, Newman NJ, et al. Profiles of obesity, weight gain, and quality of life in idiopathic intracranial hypertension (pseudotumor cerebri). Am J Ophthalmol. 2007;143(4):635–41.

    Article  PubMed  Google Scholar 

  62. • Westgate CSJ, Israelsen IME, Jensen RH, Eftekhari S. Understanding the link between obesity and headache- with focus on migraine and idiopathic intracranial hypertension. J Headache Pain. 2021;22(1):123. ()

    Article  PubMed  PubMed Central  Google Scholar 

  63. • Fortini I, Felsenfeld Junior BD. Headaches and obesity. Arq Neuropsiquiatr. 2022;80(5 Suppl 1):204–13. ()

    Article  PubMed  PubMed Central  Google Scholar 

  64. • Wang MTM, Bhatti MT, Danesh-Meyer HV. Idiopathic intracranial hypertension: Pathophysiology, diagnosis and management. J Clin Neurosci. 2022;95:172–9. ()

    Article  PubMed  CAS  Google Scholar 

  65. Walker CS, Li X, Whiting L, Glyn-Jones S, Zhang S, Hickey AJ, et al. Mice lacking the neuropeptide alpha-calcitonin gene-related peptide are protected against diet-induced obesity. Endocrinology. 2010;151(9):4257–69 (Animal-based study of anti-CGRP role in obesity).

    Article  PubMed  CAS  Google Scholar 

  66. • Etefagh HH, Shahmiri SS, Melali H, Sayadi M, Ansari H, Shahzamani A, et al. Bariatric surgery in migraine patients: CGRP level and weight loss. Obes Surg. 2022;32(11):3635–40. ()

    Article  PubMed  Google Scholar 

  67. • Jing F, Zou Q, Wang Y, Cai Z, Tang Y. Activation of microglial GLP-1R in the trigeminal nucleus caudalis suppresses central sensitization of chronic migraine after recurrent nitroglycerin stimulation. J Headache Pain. 2021;22(1):86. ()

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  68. Chen J, Wall M. Epidemiology and risk factors for idiopathic intracranial hypertension. Int Ophthalmol Clin. 2014;54(1):1–11.

    Article  PubMed  Google Scholar 

  69. Thurtell MJ, Trotti LM, Bixler EO, Rye DB, Bliwise DL, Newman NJ, et al. Obstructive sleep apnea in idiopathic intracranial hypertension: comparison with matched population data. J Neurol. 2013;260(7):1748–51.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  70. Tiseo C, Vacca A, Felbush A, Filimonova T, Gai A, Glazyrina T, et al. Migraine and sleep disorders: a systematic review. J Headache Pain. 2020;21(1):126.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Buse DC, Rains JC, Pavlovic JM, Fanning KM, Reed ML, Manack Adams A, et al. Sleep disorders among people with migraine: results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. Headache. 2019;59(1):32–45.

    Article  PubMed  Google Scholar 

  72. • Yiangou A, Mitchell JL, Nicholls M, Chong YJ, Vijay V, Wakerley BR, et al. Obstructive sleep apnoea in women with idiopathic intracranial hypertension: a sub-study of the idiopathic intracranial hypertension weight randomised controlled trial (IIH: WT). J Neurol. 2022;269(4):1945–56. ()

    Article  PubMed  Google Scholar 

  73. Wall M, McDermott MP, Kieburtz KD, Corbett JJ, Feldon SE, Friedman DI, et al. Effect of acetazolamide on visual function in patients with idiopathic intracranial hypertension and mild visual loss: the idiopathic intracranial hypertension treatment trial. JAMA. 2014;311(16):1641–51.

    Article  PubMed  Google Scholar 

  74. Celebisoy N, Gökçay F, Sirin H, Akyürekli O. Treatment of idiopathic intracranial hypertension: topiramate vs acetazolamide, an open-label study. Acta Neurol Scand. 2007;116(5):322–7.

    Article  PubMed  CAS  Google Scholar 

  75. Scotton WJ, Botfield HF, Westgate CS, Mitchell JL, Yiangou A, Uldall MS, et al. Topiramate is more effective than acetazolamide at lowering intracranial pressure. Cephalalgia. 2019;39(2):209–18.

    Article  PubMed  Google Scholar 

  76. Mollan SP, Davies B, Silver NC, Shaw S, Mallucci CL, Wakerley BR, et al. Idiopathic intracranial hypertension: consensus guidelines on management. J Neurol Neurosurg Psychiatry. 2018;89(10):1088–100.

    Article  PubMed  Google Scholar 

  77. • Yiangou A, Mitchell JL, Fisher C, Edwards J, Vijay V, Alimajstorovic Z, et al. Erenumab for headaches in idiopathic intracranial hypertension: a prospective open-label evaluation. Headache. 2021;61(1):157–69. An open-label study of an anti-CGRP medication in IIH.

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Duke University, 932 Morreene Road, Durham, 27705, NC, UK

    Sweta Sengupta & Jaskiran Vidwan

Authors
  1. Sweta Sengupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jaskiran Vidwan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sweta Sengupta.

Ethics declarations

Conflict of Interest

Sweta Sengupta, M.D. and Jaskiran Vidwan, D.O. declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sengupta, S., Vidwan, J. Overlap and Differences in Migraine and Idiopathic Intracranial Hypertension. Curr Pain Headache Rep 27, 653–662 (2023). https://doi.org/10.1007/s11916-023-01166-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-023-01166-7

Keywords

Search

Navigation