Headache in Idiopathic Intracranial Hypertension: Findings From the Idiopathic Intracranial Hypertension Treatment Trial
Objective To characterize the phenotype, headache‐related disability, medical co‐morbidities, use of symptomatic headache medications, and headache response to study interventions in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). Methods Patients with untreated IIH and mild vision...
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| Vydáno v: | Headache Ročník 57; číslo 8; s. 1195 - 1205 |
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| Hlavní autoři: | , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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United States
Wiley Subscription Services, Inc
01.09.2017
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| Témata: | |
| ISSN: | 0017-8748, 1526-4610, 1526-4610 |
| On-line přístup: | Získat plný text |
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| Abstract | Objective
To characterize the phenotype, headache‐related disability, medical co‐morbidities, use of symptomatic headache medications, and headache response to study interventions in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT).
Methods
Patients with untreated IIH and mild vision loss enrolled in the IIHTT and randomized to acetazolamide (ACZ) and weight loss or placebo (PLB) and weight loss had prospective assessment of headache disability using the Headache Impact Test‐6 (HIT‐6) questionnaire. Subjects with headache at the baseline visit were assigned a headache phenotype using the International Classification for Headache Disorders version 3 beta (ICHD‐3b). Medication overuse was determined using the participants' reported medication use for the preceding month and ICHD‐3b thresholds for diagnosing medication overuse headache. We investigated relationships between headache disability and various other clinical characteristics at baseline and at 6 months.
Results
Headache was present in 139 (84%) of the 165 enrollees at baseline. The most common headache phenotypes were migraine (52%), tension‐type headache (22%), probable migraine (16%), and probable tension‐type headache (4%). Fifty‐one (37%) participants overused symptomatic medications at baseline, most frequently simple analgesics. A similar amount of improvement in the adjusted mean (± standard error) HIT‐6 score occurred in the ACZ (–9.56 ± 1.05) and PLB groups (–9.11 ± 1.14) at 6 months (group difference −0.45, 95% CI −3.50 to 2.60, P = .77). Headache disability did not correlate with any of the studies, variables of interest, which included: the lumbar puncture opening pressure at baseline or at 6 months, body mass index, the amount of weight lost, papilledema grade, perimetric mean deviation, or the use of hormonal contraception. Headache disability was significantly associated with patient‐reported quality of life in the physical, mental, and visual domains.
Conclusions
Headache was common, of varied character, disabling, and associated with poorer quality of life in our cohort of patients with mild visual impairment. The lack of correlation between headache disability and cerebrospinal fluid (CSF) pressure at baseline and at the end of the randomized phase of the study implies that headache in IIH may be related to factors other than intracranial hypertension, and that specific headache treatment is needed in addition to therapies directed at lowering CSF pressure. |
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| AbstractList | To characterize the phenotype, headache-related disability, medical co-morbidities, use of symptomatic headache medications, and headache response to study interventions in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT).OBJECTIVETo characterize the phenotype, headache-related disability, medical co-morbidities, use of symptomatic headache medications, and headache response to study interventions in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT).Patients with untreated IIH and mild vision loss enrolled in the IIHTT and randomized to acetazolamide (ACZ) and weight loss or placebo (PLB) and weight loss had prospective assessment of headache disability using the Headache Impact Test-6 (HIT-6) questionnaire. Subjects with headache at the baseline visit were assigned a headache phenotype using the International Classification for Headache Disorders version 3 beta (ICHD-3b). Medication overuse was determined using the participants' reported medication use for the preceding month and ICHD-3b thresholds for diagnosing medication overuse headache. We investigated relationships between headache disability and various other clinical characteristics at baseline and at 6 months.METHODSPatients with untreated IIH and mild vision loss enrolled in the IIHTT and randomized to acetazolamide (ACZ) and weight loss or placebo (PLB) and weight loss had prospective assessment of headache disability using the Headache Impact Test-6 (HIT-6) questionnaire. Subjects with headache at the baseline visit were assigned a headache phenotype using the International Classification for Headache Disorders version 3 beta (ICHD-3b). Medication overuse was determined using the participants' reported medication use for the preceding month and ICHD-3b thresholds for diagnosing medication overuse headache. We investigated relationships between headache disability and various other clinical characteristics at baseline and at 6 months.Headache was present in 139 (84%) of the 165 enrollees at baseline. The most common headache phenotypes were migraine (52%), tension-type headache (22%), probable migraine (16%), and probable tension-type headache (4%). Fifty-one (37%) participants overused symptomatic medications at baseline, most frequently simple analgesics. A similar amount of improvement in the adjusted mean (± standard error) HIT-6 score occurred in the ACZ (-9.56 ± 1.05) and PLB groups (-9.11 ± 1.14) at 6 months (group difference -0.45, 95% CI -3.50 to 2.60, P = .77). Headache disability did not correlate with any of the studies, variables of interest, which included: the lumbar puncture opening pressure at baseline or at 6 months, body mass index, the amount of weight lost, papilledema grade, perimetric mean deviation, or the use of hormonal contraception. Headache disability was significantly associated with patient-reported quality of life in the physical, mental, and visual domains.RESULTSHeadache was present in 139 (84%) of the 165 enrollees at baseline. The most common headache phenotypes were migraine (52%), tension-type headache (22%), probable migraine (16%), and probable tension-type headache (4%). Fifty-one (37%) participants overused symptomatic medications at baseline, most frequently simple analgesics. A similar amount of improvement in the adjusted mean (± standard error) HIT-6 score occurred in the ACZ (-9.56 ± 1.05) and PLB groups (-9.11 ± 1.14) at 6 months (group difference -0.45, 95% CI -3.50 to 2.60, P = .77). Headache disability did not correlate with any of the studies, variables of interest, which included: the lumbar puncture opening pressure at baseline or at 6 months, body mass index, the amount of weight lost, papilledema grade, perimetric mean deviation, or the use of hormonal contraception. Headache disability was significantly associated with patient-reported quality of life in the physical, mental, and visual domains.Headache was common, of varied character, disabling, and associated with poorer quality of life in our cohort of patients with mild visual impairment. The lack of correlation between headache disability and cerebrospinal fluid (CSF) pressure at baseline and at the end of the randomized phase of the study implies that headache in IIH may be related to factors other than intracranial hypertension, and that specific headache treatment is needed in addition to therapies directed at lowering CSF pressure.CONCLUSIONSHeadache was common, of varied character, disabling, and associated with poorer quality of life in our cohort of patients with mild visual impairment. The lack of correlation between headache disability and cerebrospinal fluid (CSF) pressure at baseline and at the end of the randomized phase of the study implies that headache in IIH may be related to factors other than intracranial hypertension, and that specific headache treatment is needed in addition to therapies directed at lowering CSF pressure. To characterize the phenotype, headache-related disability, medical co-morbidities, use of symptomatic headache medications, and headache response to study interventions in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). Patients with untreated IIH and mild vision loss enrolled in the IIHTT and randomized to acetazolamide (ACZ) and weight loss or placebo (PLB) and weight loss had prospective assessment of headache disability using the Headache Impact Test-6 (HIT-6) questionnaire. Subjects with headache at the baseline visit were assigned a headache phenotype using the International Classification for Headache Disorders version 3 beta (ICHD-3b). Medication overuse was determined using the participants' reported medication use for the preceding month and ICHD-3b thresholds for diagnosing medication overuse headache. We investigated relationships between headache disability and various other clinical characteristics at baseline and at 6 months. Headache was present in 139 (84%) of the 165 enrollees at baseline. The most common headache phenotypes were migraine (52%), tension-type headache (22%), probable migraine (16%), and probable tension-type headache (4%). Fifty-one (37%) participants overused symptomatic medications at baseline, most frequently simple analgesics. A similar amount of improvement in the adjusted mean (± standard error) HIT-6 score occurred in the ACZ (-9.56 ± 1.05) and PLB groups (-9.11 ± 1.14) at 6 months (group difference -0.45, 95% CI -3.50 to 2.60, P = .77). Headache disability did not correlate with any of the studies, variables of interest, which included: the lumbar puncture opening pressure at baseline or at 6 months, body mass index, the amount of weight lost, papilledema grade, perimetric mean deviation, or the use of hormonal contraception. Headache disability was significantly associated with patient-reported quality of life in the physical, mental, and visual domains. Headache was common, of varied character, disabling, and associated with poorer quality of life in our cohort of patients with mild visual impairment. The lack of correlation between headache disability and cerebrospinal fluid (CSF) pressure at baseline and at the end of the randomized phase of the study implies that headache in IIH may be related to factors other than intracranial hypertension, and that specific headache treatment is needed in addition to therapies directed at lowering CSF pressure. Objective To characterize the phenotype, headache‐related disability, medical co‐morbidities, use of symptomatic headache medications, and headache response to study interventions in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). Methods Patients with untreated IIH and mild vision loss enrolled in the IIHTT and randomized to acetazolamide (ACZ) and weight loss or placebo (PLB) and weight loss had prospective assessment of headache disability using the Headache Impact Test‐6 (HIT‐6) questionnaire. Subjects with headache at the baseline visit were assigned a headache phenotype using the International Classification for Headache Disorders version 3 beta (ICHD‐3b). Medication overuse was determined using the participants' reported medication use for the preceding month and ICHD‐3b thresholds for diagnosing medication overuse headache. We investigated relationships between headache disability and various other clinical characteristics at baseline and at 6 months. Results Headache was present in 139 (84%) of the 165 enrollees at baseline. The most common headache phenotypes were migraine (52%), tension‐type headache (22%), probable migraine (16%), and probable tension‐type headache (4%). Fifty‐one (37%) participants overused symptomatic medications at baseline, most frequently simple analgesics. A similar amount of improvement in the adjusted mean (± standard error) HIT‐6 score occurred in the ACZ (–9.56 ± 1.05) and PLB groups (–9.11 ± 1.14) at 6 months (group difference −0.45, 95% CI −3.50 to 2.60, P = .77). Headache disability did not correlate with any of the studies, variables of interest, which included: the lumbar puncture opening pressure at baseline or at 6 months, body mass index, the amount of weight lost, papilledema grade, perimetric mean deviation, or the use of hormonal contraception. Headache disability was significantly associated with patient‐reported quality of life in the physical, mental, and visual domains. Conclusions Headache was common, of varied character, disabling, and associated with poorer quality of life in our cohort of patients with mild visual impairment. The lack of correlation between headache disability and cerebrospinal fluid (CSF) pressure at baseline and at the end of the randomized phase of the study implies that headache in IIH may be related to factors other than intracranial hypertension, and that specific headache treatment is needed in addition to therapies directed at lowering CSF pressure. Objective To characterize the phenotype, headache-related disability, medical co-morbidities, use of symptomatic headache medications, and headache response to study interventions in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). Methods Patients with untreated IIH and mild vision loss enrolled in the IIHTT and randomized to acetazolamide (ACZ) and weight loss or placebo (PLB) and weight loss had prospective assessment of headache disability using the Headache Impact Test-6 (HIT-6) questionnaire. Subjects with headache at the baseline visit were assigned a headache phenotype using the International Classification for Headache Disorders version 3 beta (ICHD-3b). Medication overuse was determined using the participants' reported medication use for the preceding month and ICHD-3b thresholds for diagnosing medication overuse headache. We investigated relationships between headache disability and various other clinical characteristics at baseline and at 6 months. Results Headache was present in 139 (84%) of the 165 enrollees at baseline. The most common headache phenotypes were migraine (52%), tension-type headache (22%), probable migraine (16%), and probable tension-type headache (4%). Fifty-one (37%) participants overused symptomatic medications at baseline, most frequently simple analgesics. A similar amount of improvement in the adjusted mean (± standard error) HIT-6 score occurred in the ACZ (-9.56±1.05) and PLB groups (-9.11±1.14) at 6 months (group difference -0.45, 95% CI -3.50 to 2.60, P=.77). Headache disability did not correlate with any of the studies, variables of interest, which included: the lumbar puncture opening pressure at baseline or at 6 months, body mass index, the amount of weight lost, papilledema grade, perimetric mean deviation, or the use of hormonal contraception. Headache disability was significantly associated with patient-reported quality of life in the physical, mental, and visual domains. Conclusions Headache was common, of varied character, disabling, and associated with poorer quality of life in our cohort of patients with mild visual impairment. The lack of correlation between headache disability and cerebrospinal fluid (CSF) pressure at baseline and at the end of the randomized phase of the study implies that headache in IIH may be related to factors other than intracranial hypertension, and that specific headache treatment is needed in addition to therapies directed at lowering CSF pressure. |
| Author | Mejico, Luis J. McDermott, Michael Friedman, Deborah I. Gao, Shan Subramanian, Prem S. Quiros, Peter A. Wall, Michael |
| AuthorAffiliation | 5 SUNY UMU - Neurology & Ophthalmology, Syracuse, New York, United States 6 University of Rochester School of Medicine and Dentistry – Biostatistics, Rochester, New York, United States 3 University of Texas Southwestern Medical Center - Ophthalmology, Dallas, Texas, United States 7 University of Iowa – Ophthalmology, Iowa City, Iowa, United States 1 University of California Los Angeles - Ophthalmology, Los Angeles, California, United States 4 University of Colorado Denver School of Medicine – Ophthalmology, Aurora, Colorado, United States 2 University of Texas Southwestern Medical Center - Neurology & Neurotherapeutics, Dallas, Texas, United States |
| AuthorAffiliation_xml | – name: 3 University of Texas Southwestern Medical Center - Ophthalmology, Dallas, Texas, United States – name: 1 University of California Los Angeles - Ophthalmology, Los Angeles, California, United States – name: 7 University of Iowa – Ophthalmology, Iowa City, Iowa, United States – name: 4 University of Colorado Denver School of Medicine – Ophthalmology, Aurora, Colorado, United States – name: 5 SUNY UMU - Neurology & Ophthalmology, Syracuse, New York, United States – name: 2 University of Texas Southwestern Medical Center - Neurology & Neurotherapeutics, Dallas, Texas, United States – name: 6 University of Rochester School of Medicine and Dentistry – Biostatistics, Rochester, New York, United States |
| Author_xml | – sequence: 1 givenname: Deborah I. surname: Friedman fullname: Friedman, Deborah I. email: deborah.friedman@utsouthwestern.edu organization: University of California Los Angeles – sequence: 2 givenname: Peter A. orcidid: 0000-0002-1133-9179 surname: Quiros fullname: Quiros, Peter A. email: Quiros@jsei.ucla.edu organization: University of Texas Southwestern Medical Center – sequence: 3 givenname: Prem S. surname: Subramanian fullname: Subramanian, Prem S. organization: SUNY UMU – sequence: 4 givenname: Luis J. surname: Mejico fullname: Mejico, Luis J. organization: SUNY UMU – sequence: 5 givenname: Shan surname: Gao fullname: Gao, Shan organization: University of Rochester School of Medicine and Dentistry – sequence: 6 givenname: Michael surname: McDermott fullname: McDermott, Michael organization: Neurology; Center for Neurotherapeutics, University of Rochester School of Medicine and Dentistry – sequence: 7 givenname: Michael surname: Wall fullname: Wall, Michael organization: University of Iowa |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28752894$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | 2017 American Headache Society 2017 American Headache Society. |
| Copyright_xml | – notice: 2017 American Headache Society – notice: 2017 American Headache Society. |
| CorporateAuthor | and the NORDIC IIHTT Study Group |
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| Keywords | medication overuse Headache Impact Test-6 headache idiopathic intracranial hypertension |
| Language | English |
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| Notes | Conflicts of Interest The authors report no relevant conflicts of interest. U.S. Department of Health and Human Services, National Institutes of Health, National Eye Institute: u10 EY017281. Funding ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Undefined-3 |
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To characterize the phenotype, headache‐related disability, medical co‐morbidities, use of symptomatic headache medications, and headache response to... To characterize the phenotype, headache-related disability, medical co-morbidities, use of symptomatic headache medications, and headache response to study... Objective To characterize the phenotype, headache-related disability, medical co-morbidities, use of symptomatic headache medications, and headache response to... |
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| Title | Headache in Idiopathic Intracranial Hypertension: Findings From the Idiopathic Intracranial Hypertension Treatment Trial |
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