Evaluation of predictive factors for idiopathic intracranial hypertension in different clinical presentations

Introduction: Idiopathic Intracranial Hypertension (IIH) is characterized by an increase in intracranial pressure without any known cause. It presents with symptoms such as headaches, visual loss, pulsatile tinnitus, and diplopia, and has various clinical courses with an unclear pathophysiology. This study aims to compare predictive factors among three subgroups of IIH: those with remission (single attack), those with relapses, and those with a transformation to migraine-like headaches, in order to determine factors influencing the disease course. Method: This retrospective study was conducted at Celal Bayar University Neurology Clinic between 2011 and 2023. A total of 135 patients diagnosed with IIH, admitted to the hospital or followed up in neurology, headache, and neuro-ophthalmology outpatient clinics, were examined in terms of demographic data, detailed clinical histories, comorbid diseases, laboratory results related to secondary causes of IIH, medication usage, cranial imaging, and detailed neurological and neuro-ophthalmological examinations. A comparison was made between the three subgroups of IIH: those with remission (single attack), those with relapses, and those with a transformation to migraine-like headaches. After binary group comparisons, univariate and multivariate analyses were performed on parameters that were statistically significant. Results: According to clinical courses, there were 87 (64.4%) patients in the single attack group, 17 (12.6%) in the relapse group, and 31 (23%) in the migraine-like headache group. In the comparison of the single attack group with the migraine-like headache group, the presence of allodynia (p: <0.001), neck and back pain (p: 0.030), BMI >27.8 kg/m2 (p: 0.009), and a history of migraine (p: <0.001) were statistically significant. In the comparison of the single attack group with the relapse group, the presence of tinnitus (p: 0.029) was statistically significant. Conclusion: Allodynia, neck and back pain, a history of migraine, and BMI >27.8 kg/m2 were considered the most important risk factors for the development of migraine-like headaches in IIH patients. For relapse development, high LP-AB and the presence of tinnitus were identified as the most significant risk factors. Our study is the first to evaluate the predictive factors of the three clinical subgroups of IIH in the literature. Keywords: Idiopathic Intracranial Hypertension, Allodynia, Migraine, Body Mass Index, Tinnitus