The prevalence of papilledema in patients with migraine: a crucial cooccurrence of migraine and idiopathic intracranial hypertension

DOI: https://doi.org/10.1007/s10072- 020- 04473- 8

Abstract-Summary We aimed to investigate the prevalence of idiopathic intracranial hypertension (IIH) in patients with migraine by screening for papilledema.

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We have included all the patients with migraine who applied to our neurology

clinic during December 2019 and accepted to participate in the study.

The demographic and clinical characteristics including migraine subtype (epi- sodic/chronic), headache frequency per month, and headache characteristics of all patients were interrogated.

Fundus examination was performed in all of the patients and the presence of

papilledema was noted.

Papilledema was determined in 10 (6%) patients. Comparative analyses between episodic migraineurs and chronic migraineurs revealed that female gender was more prevalent in chronic migraineurs (p = 0.00) and the comorbidities of FM and CFS were more common in chronic migraineurs.

Papilledema was found to be more common in chronic migraineurs. Our results may suggest that IIH should be kept in mind as a notable comorbidity in migraineurs, particularly in the subgroup of obese patients with chronic migraine. Extended: Papilledema was more prevalent in the CM group (in 7/123 of CM

patients (9.3%), 3/35 of EM patients (5.6%), p value = 0.014).

Future studies of larger case series (including LP investigations or OCT exami- nations) are warranted to confirm our results as well as propose possible recommen- dations regarding the related clinical practice.

Introduction Several reports have drawn attention to a subtype of IIH without papilledema (IIHWOP), and the diagnosis of which may constitute strictly a challenging issue [484–486].

The coexistence of migraine and IIHWOP was first investigated systematically by Mathew and others in their study on 85 refractory migraineurs, in which they found IIHWOP in twelve of the patients (14%) [486].

Almost all of these reports focused on IIHWOP in the context of the challenges of its diagnosis and perhaps on certain properties such as its rareness and its status as an underrecognized entity in comparison with IIH with papilledema.

The prevalence of IIH with papilledema in migraineurs has not been systemati-

cally investigated up until the present.

In this cross-sectional study, we aimed to investigate the prevalence of IIH with papilledema in our patient group with migraines by conducting a routine fundus examination on all of the patients.

Materials and Methods The diagnosis of migraine headaches in the patients was based on the four diagnos- tic criteria of the “International Classification of Headache Disorders 3rd edi- tion” [487].

The demographic and clinical characteristics including migraine subtype (epi- sodic/chronic), headache frequency per month, and headache characteristics of all patients were interrogated.

All patients with migraine were asked to perform the following self-reported questionnaires for the assessment of headache severity and severity of chronic fatigue.

2.3 Comorbidities

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Fundus examination was performed in all of the patients and the presence of

papilledema was noted.

Ocular ultrasound, mode B, was performed in only one patient with slight papill-

edema which also supported the diagnosis.

The LP was performed while the patients were lying in the lateral decubitus

position.

All of the patients with LP investigation also met the criteria for definitive diag- nosis of IIH according to the revised diagnostic criteria by Friedman and oth- ers [488].

Results Papilledema was more prevalent in the CM group (in 7/123 of CM patients (9.3%), 3/35 of EM patients (5.6%), p value = 0.014).

The mean BMI was higher in the CM group and obese patients were more preva-

lent in the CM group.

In one of these patients with papilledema, it was learnt that a definitive diagnosis

of IIH had been made one year ago in a distinct center.

The patient had not attended follow-ups; therefore, the patient could not receive

adequate therapy for IIH.

None of the patients with papilledema had a history of a drug intake that could

induce increased intracranial hypertension.

Six of the patients with papilledema were taking prophylactic therapy for

migraine at admission to our clinic.

Due to the low number of patients with papilledema, comparative analyses

between papilledema (+) and (−) patients were not performed. Discussion This method may explain the higher rates of IIH in their cohort (86.6%) in compari- son with the papilledema rates in our cohort of patients with CM (9.3%).

However, the authors made the diagnosis of IIH through LP examinations, and they did not detect papilledema in any of their patients with CM, which was discor- dant with our results.

Surely, a crucial result of this study was that papilledema was found to be more

prevalent in the subgroup of patients with CM.

Based on our study results, we suggest to conduct a careful clinical evaluation and perform a fundoscopic examination in all patients with migraine to avoid diag- nostic errors.

In light of these findings and results of regression analyses, we suggest that a possible comorbid IIH should be considered particularly in obese patients with CM, to avoid misdiagnosis as well as delay in the initiation of appropriate treatments.

Acknowledgement A machine generated summary based on the work of Onder, Halil; Ulusoy, Ersin Kasim; Aslanyavrusu, Memet; Akturk, Tulin; Arslan, Guven; Akkurt, Ibrahim; Erkan, Erol2020 in Neurological Sciences

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Coronary artery calcification score in migraine patients