Idiopathic Intracranial Hypertension (IIH), previously known as Pseudotumor Cerebri, should be considered as a possible etiology of recurrent, often daily, headaches, particularly in obese, female patients.
The pain is typically throbbing, sometimes unilateral, and severe. In addition to headache, these patients often present with transient visual abnormality (72%), pulsatile tinnitus (60%), photopsia (seeing lights, flashes, colors) (54%), retrobulbar pain (44%), diplopia (38%), and sustained visual abnormality (26%).
The most commonly encountered physical examination findings are (1) papilledema - the greater, the higher the risk for vision loss, (2) visual field loss (always check!), and (3) sixth cranial nerve palsy - due to increased pressure on this long-coursing intracranial nerve.
Wall M, George D. Idiopathic Intracranial Hypertension. A Prospective Study of 50 Patients. Brain. 1991; 114 (Pt 1A): 155.
Wall M, White WN. Asymmetric Papilledema in Idiopathic Intracranial Hypertension: Prospective Intraocular Comparison of Sensory Visual Function. Invest Ophthalmol Vis Sci. 1998; 39(1): 134.
