The most commonly prescribed medication is Acetazolamide (Diamox), a carbonic anhydrase inhibitor used for glaucoma, some types of epilepsy and fluid retention. It reduces CSF production in most patients. Nearly all patients taking Diamox suffer side effects, tingling of the fingers and toes are the most common. Patients prescribed Diamox or any other diuretic should have their progress monitored closely and have regular blood tests. They may be advised to increase their intake of potassium as the body's natural stores can be depleted. As well as standard Diamox a sustained release form of the drug is also available, 'Diamox SR'. Many patients find that the side effects are reduced in comparison with the standard form. Furosemide, a diuretic, is sometimes prescribed but has been proven to have little effect on raised ICP.
On occasion Furosemide and Diamox are used in conjunction with each other. In extreme cases where sight is threatened patients may be treated with a short dose of steroids. Other medications prescribed include Topirimate, Amitriptyline and more. Analgesic’s (pain killers) are used to treat the pain associated with IIH headache, with varying degrees of success. As with all pain killers care must be taken as many can be addictive and cause medication overuse headache to our MOH leaflet here and some can have severe side-effects.
Some IIH patients are treated with therapeutic lumbar punctures (LPs) to remove excess CSF on a regular basis.
Non invasive pressure testing is just starting to be evaluated in the UK. Its disadvantage is that no CSF can be drained off to reduce pressure by this technique. Nevertheless, it is also being evaluated by NASA Space Agency for possible use as a CSF pressure measuring device on future space missions as some astronauts have developed IIH-like symptoms during prolonged weightlessness.
There is now definitive evidence that weight and IIH are related. Weight loss has been shown to be the only treatment to modify the underlying condition. Over 90% of patients diagnosed with IIH are overweight women, suggesting that there is a link between obesity and IIH. Recent studies have shown that weight loss is an effective treatment to reduce papilloedema and headaches, putting IIH in to remission. The IIH:WT has shown that a 24% reduction in body weight is required to normalise Intracranial Pressure (ICP) reduce headache and improve quality of life.