Compare clinical characteristics of refractory idiopathic intracranial hypertension (rIIH) in patients with body mass index (BMI) ≥35 vs. <35.

While obesity is common in IIH, more research is needed to compare rIIH clinical features based on BMI.

This is an observational study assessing symptoms, trans-stenosis pressure gradient (TSPG), lumbar puncture opening pressure (LPOP), medication use, and quality of life (QOL) in rIIH patients undergoing venous manometry (VM) between April 2023 and July 2024 at Thomas Jefferson Headache Center. Data was stratified by BMI.

Twenty female patients with primary IIH were included (mean age 35.7±8.7 years, mean BMI 36.2±7.8, gastric surgery 25.0%, GLP-1 agonist 20.0%). Racial distribution was 35.0% Caucasian, 45.0% African American, and 20.0% Hispanic. Comparing BMI≥35 vs. BMI<35, there were no statistical differences between IIH features: headache (92.3% vs. 85.7%), pulsatile tinnitus (84.6% vs. 71.4%), brain fog (53.8% vs. 42.9%), papilledema (53.8% vs. 71.4%), and visual disturbances (92.3% vs. 100%). TSPG≥8 was reported in 76.9% of patients with BMI≥35 with a mean LPOP of 35.8±9.9, compared to 42.9% and 30.1±4.4 in BMI<35 respectively. No significant difference was found between BMI vs. LPOP, TSPG, and VM measurement of superior sagittal sinus and torcula. No significant correlation was found between BMI≥35 and BMI<35 for overall IIH QOL impact (66.8±35.6 vs. 58.7±35.6; scored out of 100), monthly headache days (17.8±11.2 vs. 18.2±10.6), and monthly acute medication use days (8.9±10.0 vs. 12.8±12.7). Prior to VM, 84.6% of patients with BMI≥35 were on multiple medications (BMI<35, 57.1%).

In this rIIH population, BMI≥35 was not associated with greater IIH symptom severity, QOL impact, or stenosis than BMI<35. However, the study was limited by a small sample size and only patients who underwent venous manometry. Larger studies are needed to evaluate the correlation as it may evolve IIH management with emerging weight loss medications.