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Open Access 01-07-2014 | Original Communication

Intracranial pressure in unresponsive chronic migraine

Authors: Roberto De Simone, Angelo Ranieri, Silvana Montella, Paolo Cappabianca, Mario Quarantelli, Felice Esposito, Giuseppe Cardillo, Vincenzo Bonavita

Published in: Journal of Neurology | Issue 7/2014

Abstract

To assess the prevalence and possible pathogenetic involvement of raised intracranial pressure in patients presenting with unresponsive chronic migraine (CM), we evaluated the intracranial opening pressure (OP) and clinical outcome of a single cerebrospinal fluid withdrawal by lumbar puncture in 44 consecutive patients diagnosed with unresponsive chronic/transformed migraine and evidence of sinus stenosis at magnetic resonance venography. The large majority of patients complained of daily or near-daily headache. Thirty-eight (86.4 %) had an OP >200 mmH₂O. Lumbar puncture-induced normalization of intracranial pressure resulted in prompt remission of chronic pain in 34/44 patients (77.3 %); and an episodic pattern of headache was maintained for 2, 3 and 4 months in 24 (54.6 %), 20 (45.4 %) and 17 (38.6 %) patients, respectively. The medians of overall headache days/month and of disabling headache days/month significantly decreased (p < 0.0001) at each follow-up versus baseline. Despite the absence of papilledema, 31/44 (70.5 %) patients fulfilled the ICHD-II criteria for “Headache attributed to Intracranial Hypertension”. Our findings indicate that most patients diagnosed with unresponsive CM in specialized headache clinics may present an increased intracranial pressure involved in the progression and refractoriness of pain. Moreover, a single lumbar puncture with cerebrospinal fluid withdrawal results in sustained remission of chronic pain in many cases. Prospective controlled studies are needed before this procedure can be translated into clinical practice. Nonetheless, we suggest that intracranial hypertension without papilledema should be considered in all patients with almost daily migraine pain, with evidence of sinus stenosis, and unresponsive to medical treatment referred to specialized headache clinics.

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Wang SJ, Silberstein SD, Patterson S et al (1998) Idiopathic intracranial hypertension without papilledema: a case–control study in a headache center. Neurology 51:245–249CrossRefPubMed

Mathew NT, Ravishankar K, Sanin LC (1996) Co-existence of migraine and idiopathic intracranial hypertension without papilledema. Neurology 46:1226–1230CrossRefPubMed

Vieira DS, Masruha MR, Goncalves AL et al (2008) Idiopathic intracranial hypertension with and without papilloedema in a consecutive series of patients with chronic migraine. Cephalalgia 28:609–613CrossRefPubMed

Ekizoglu E, Baykan B, Orhan EK et al (2012) The analysis of allodynia in patients with idiopathic intracranial hypertension. Cephalalgia 32:1049–1058CrossRefPubMed

De Simone R, Ranieri A, Fiorillo C et al (2010) Is idiopathic intracranial hypertension without papilledema a risk factor for migraine progression? Neurol Sci 31:411–415CrossRefPubMed

De Simone R, Ranieri A, Montella S et al (2012) Sinus venous stenosis-associated idiopathic intracranial hypertension without papilledema as a powerful risk factor for progression and refractoriness of headache. Curr Pain Headache Rep 16:261–269CrossRefPubMed

Bono F, Salvino D, Tallarico T et al (2010) Abnormal pressure waves in headache sufferers with bilateral transverse sinus stenosis. Cephalalgia 30:1419–1425CrossRefPubMed

Fofi L, Giugni E, Vadalà R et al (2012) Cerebral transverse sinus morphology as detected by MR venography in patients with chronic migraine. Headache 52:1254–1261CrossRefPubMed

Montella S, Ranieri A, Marchese M et al (2013) Primary stabbing headache: a new dural sinus stenosis-associated primary headache? Neurol Sci 34(Suppl 1):S157–S159CrossRefPubMed

10.

Donnet A, Valade D, Houdart E (2013) Primary cough headache, primary exertional headache, and primary headache associated with sexual activity: a clinical and radiological study. Neuroradiology 55:297–305CrossRefPubMed

11.

Wilson MH, Davagnanam I, Holland G et al (2013) Cerebral venous system and anatomical predisposition to high-altitude headache. Ann Neurol 73:381–389CrossRefPubMed

12.

Farb RI, Vanek I, Scott JN et al (2003) Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis. Neurology 60:1418–1424CrossRefPubMed

13.

Higgins J, Gillard J, Owler B et al (2004) MR venography in idiopathic intracranial hypertension: unappreciated and misunderstood. J Neurol Neurosurg Psychiatry 75(4):621–625PubMedCentralCrossRefPubMed

14.

Fera F, Bono F, Messina D et al (2005) Comparison of different MR venography techniques for detecting transverse sinus stenosis in idiopathic intracranial hypertension. J Neurol 252:1021–1025CrossRefPubMed

15.

Bono F, Messina D, Giliberto C et al (2006) Bilateral transverse sinus stenosis predicts IIH without papilledema in patients with migraine. Neurology 67(3):419–423CrossRefPubMed

16.

Friedman DI, Liu GT, Digre KB (2013) Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 81:1159–1165CrossRefPubMed

17.

De Simone R, Ranieri A, Bonavita V (2010) Advancement in idiopathic intracranial hypertension pathogenesis: focus on sinus venous stenosis. Neurol Sci 31(Suppl 1):S33–S39CrossRefPubMed

18.

Puffer RC, Mustafa W, Lanzino G (2013) Venous sinus stenting for idiopathic intracranial hypertension: a review of the literature. J Neurointerv Surg 5:483–486CrossRefPubMed

19.

Biousse V, Bruce BB, Newman NJ (2012) Update on the pathophysiology and management of idiopathic intracranial hypertension. J Neurol Neurosurg Psychiatry 83:488–494PubMedCentralCrossRefPubMed

20.

De Simone R, Marano E, Fiorillo C et al (2005) Sudden re-opening of collapsed transverse sinuses and longstanding clinical remission after a single lumbar puncture in a case of idiopathic intracranial hypertension. Pathogenetic implications. Neurol Sci 25:342–344CrossRefPubMed

21.

Silberstein SD, Lipton RB, Sliwinski M (1996) Classification of daily and near-daily headaches: field trial of revised IHS criteria. Neurology 47:871–875CrossRefPubMed

22.

Committee Headache Classification, Olesen J, Bousser MG, Diener HC et al (2006) New appendix criteria open for a broader concept of chronic migraine. Cephalalgia 26:742–746CrossRef

23.

Carson D, Serpell M (1996) Choosing the best needle for diagnostic lumbar puncture. Neurology 47:33–37CrossRefPubMed

24.

Corbett JJ, Mehta MP (1983) Cerebrospinal fluid pressure in normal obese subjects and patients with pseudotumor cerebri. Neurology 33:1386–1388CrossRefPubMed

25.

De Simone R, Ranieri A, Montella S et al (2014) Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 82(11):1011–1012. doi:10.1212/WNL.0000000000000200

26.

Wall M (2010) Idiopathic intracranial hypertension. Neurol Clin 28:593–617PubMedCentralCrossRefPubMed

27.

Bono F, Lupo MR, Serra P et al (2002) Obesity does not induce abnormal CSF pressure in subjects with normal cerebral MR venography. Neurology 59:1641–1643CrossRefPubMed

28.

Whiteley W, Al Shahi R, Warlow CP et al (2006) CSF opening pressure: reference interval and the effect of body mass index. Neurology 67:1690–1691CrossRefPubMed

29.

Bono F, Cristiano D, Mastrandrea C et al (2010) The upper limit of normal CSF opening pressure is related to bilateral transverse sinus stenosis in headache sufferers. Cephalalgia 30:145–151CrossRefPubMed

30.

Headache Classification Subcommittee of the International Headache Society (2004) The International classification of headache disorders second edition. Cephalalgia 24(Suppl 1):9–160

31.

Digre KB, Nakamoto BK, Warner JE et al (2009) A comparison of idiopathic intracranial hypertension with and without papilledema. Headache 49:185–193PubMedCentralCrossRefPubMed

32.

De Simone R, Coppola G, Ranieri A et al (2007) Validation of AIDA Cefalee, a computer-assisted diagnosis database for the management of headache patients. Neurol Sci 28(Suppl 2):S213–S216CrossRefPubMed

33.

Bezov D, Lipton RB, Ashina S (2010) Post-dural puncture headache: part i diagnosis, epidemiology, etiology, and pathophysiology. Headache 50:1144–1152CrossRefPubMed

34.

Clark JW, Solomon GD, Senanayake PD et al (1996) Substance P concentration and history of headache in relation to postlumbar puncture headache: towards prevention. J Neurol Neurosurg Psychiatry 60:681–683PubMedCentralCrossRefPubMed

35.

Wessa P, (2009), Bias Reduced Logistic Regression (v1.0.4) in Free Statistics Software (v1.1.23-r7), Office for Research Development and Education, URL http://www.wessa.net/rwasp_logisticregression.wasp/

36.

Torbey MT, Geocadin RG, Razumovsky AY et al (2004) Utility of CSF pressure monitoring to identify idiopathic intracranial hypertension without papilledema in patients with chronic daily headache. Cephalalgia 24:495–502CrossRefPubMed

37.

Spence JD, Amacher AL, Willis NR (1980) Benign intracranial hypertension without papilledema. Role of 24-h cerebrospinal fluid pressure monitoring in diagnosis and management. Neurosurgery 7:326–336CrossRefPubMed

38.

De Simone R, Marano E, Bilo L et al (2006) Idiopathic intracranial hypertension without headache. Cephalalgia 26:1020–1021CrossRefPubMed

39.

De Simone R, Ranieri A, Cardillo G et al (2011) High prevalence of bilateral transverse sinus stenosis-associated IIHWOP in unresponsive chronic headache sufferers: pathogenetic implications in primary headache progression. Cephalalgia 31:763–765CrossRefPubMed

40.

Celebisoy N, Gökçay F, Sirin H et al (2007) Treatment of idiopathic intracranial hypertension: topiramate vs acetazolamide, an open-label study. Acta Neurol Scand 116:322–327CrossRefPubMed

Title: Intracranial pressure in unresponsive chronic migraine
Authors: Roberto De Simone
Angelo Ranieri
Silvana Montella
Paolo Cappabianca
Mario Quarantelli
Felice Esposito
Giuseppe Cardillo
Vincenzo Bonavita
Publication date: 01-07-2014
Publisher: Springer Berlin Heidelberg
Published in: Journal of Neurology / Issue 7/2014
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-014-7355-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intracranial pressure in unresponsive chronic migraine

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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