title: Idiopathic intracranial hypertension: Clinical nosography and field-testing of the ICHD diagnostic criteria. A case-control study.
abstract: OBJECTIVE
  The aims of this article are to characterize the headache in idiopathic intracranial hypertension (IIH) and to field-test the ICHD diagnostic criteria for headache attributed to IIH.
  
  
  METHODS
  We included 44 patients with new-onset IIH. Thirty-four patients with suspected but unconfirmed IIH served as controls. Headache and other IIH-related symptoms were assessed by a detailed standardized interview. In participants referred before diagnostic lumbar puncture (n = 67), we recorded headache intensity before and after cerebrospinal fluid (CSF) withdrawal.
  
  
  RESULTS
  Headache in patients with IIH was daily occurring in 86%, focal in 84% and pulsating in 52%. Aggravation of headache by coughing or straining and relief after CSF withdrawal were significantly more frequent in patients than in controls (p ≤ 0.002). From the ICHD-2 to the ICHD-3 beta classification the sensitivity increased from 60% to 86% whereas the specificity decreased from 86% to 53%. Based on our data the headache criteria can be revised to increase sensitivity to 95% and specificity to 65%.
  
  
  CONCLUSIONS
  Aggravation of headache by coughing or straining, relief after CSF withdrawal, retrobulbar pain and pulsatile tinnitus may suggest intracranial hypertension. Based on data from a well-defined IIH cohort, we propose a revision of the ICDH-3 beta diagnostic criteria with improved clinical applicability and increased sensitivity and specificity.
authors.affiliation: Danish Headache Centre, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark.
authors.forename: Hanne M
authors.initials: HM
authors.lastname: Yri
authors.affiliation: Danish Headache Centre, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark rigmor.jensen@regionh.dk.
authors.forename: Rigmor H
authors.initials: RH
authors.lastname: Jensen
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003371:Cough / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006261:Headache / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011559:Pseudotumor Cerebri / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D013129:Spinal Puncture / Q000379:methods / Q000592:standards*; D055815:Young Adult
keywords: Idiopathic intracranial hypertension; case-control studies; diagnostic; headache; pseudotumor cerebri