The Role of Obesity Treatment in the Management of Idiopathic Intracranial Hypertension
DOI:
https://doi.org/10.12775/QS.2025.47.66603Keywords
idiopathic intracranial hypertension, pseudotumor cerebri, obesityAbstract
Introduction: Idiopathic intracranial hypertension (IIH) is a rare neurological condition characterized by elevated intracranial pressure in the absence of a detectable cause. It predominantly affects obese women of childbearing age. The underlying pathophysiological mechanisms remain unclear, but increasing evidence suggests a significant role of obesity-related metabolic and hormonal disturbances.
Materials and methods: A review of selected literature in the PubMed database was conducted, using the following keywords: “idiopathic intracranial hypertension”, “pseudotumor cerebri”, “obesity”
Summary: The development of IIH appears to be multifactorial, involving impaired cerebrospinal fluid dynamics, venous outflow obstruction, and endocrine dysfunction. Obesity contributes through increased intra-abdominal and intracranial pressure, altered secretion of adipokines (such as leptin), and chronic low-grade inflammation. The review highlights the role of obesity as a modifiable risk factor and the impact of weight loss on symptom relief and disease progression.
Conclusions: Understanding the link between obesity and IIH is crucial for effective prevention and treatment. Multidisciplinary care, including neurologists, ophthalmologists, and nutritionists, should focus on weight management and early detection of visual complications. Further research is needed to clarify the molecular mechanisms involved and to develop more targeted therapeutic strategies.
References
Abbott, S., Chan, F., Tahrani, A. A., Wong, S. H., Campbell, F. E. J., Parmar, C., Pournaras, D. J., Denton, A., Sinclair, A. J., & Mollan, S. P. (2023). Weight Management Interventions for Adults With Idiopathic Intracranial Hypertension: A Systematic Review and Practice Recommendations. Neurology, 101(21), e2138–e2150. https://doi.org/10.1212/WNL.0000000000207866
Abdelghaffar, M., Hussein, M., Abdelkareem, S. A., & Elshebawy, H. (2022). Sex hormones, CSF and serum leptin in patients with idiopathic intracranial hypertension. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 58(1), 39. https://doi.org/10.1186/s41983-022-00473-x
Adderley, N. J., Subramanian, A., Nirantharakumar, K., Yiangou, A., Gokhale, K. M., Mollan, S. P., & Sinclair, A. J. (2019). Association Between Idiopathic Intracranial Hypertension and Risk of Cardiovascular Diseases in Women in the United Kingdom. JAMA Neurology, 76(9), 1088–1098. https://doi.org/10.1001/jamaneurol.2019.1812
Aj, S., Ea, W., Ma, B., Ap, van B., Ip, K., Ba, H., Pi, M., Pg, N., Pm, S., S, R., & Jw, T. (2010). Cerebrospinal fluid corticosteroid levels and cortisol metabolism in patients with idiopathic intracranial hypertension: A link between 11beta-HSD1 and intracranial pressure regulation? The Journal of Clinical Endocrinology and Metabolism, 95(12). https://doi.org/10.1210/jc.2010-0729
Akay, R., Kamisli, O., Kahraman, A., Oner, S., & Tecellioglu, M. (2015). Evaluation of aqueductal CSF flow dynamics with phase contrast cine MR imaging in idiopathic intracranial hypertension patients: Preliminary results. European Review for Medical and Pharmacological Sciences, 19(18), 3475–3479. https://pubmed.ncbi.nlm.nih.gov/26439045/
Alimajstorovic, Z., Mollan, S. P., Grech, O., Mitchell, J. L., Yiangou, A., Thaller, M., Lyons, H., Sassani, M., Seneviratne, S., Hancox, T., Jankevics, A., Najdekr, L., Dunn, W., & Sinclair, A. J. (2023). Dysregulation of Amino Acid, Lipid, and Acylpyruvate Metabolism in Idiopathic Intracranial Hypertension: A Non-targeted Case Control and Longitudinal Metabolomic Study. Journal of Proteome Research, 22(4), 1127–1137. https://doi.org/10.1021/acs.jproteome.2c00449
Aung, A. B., Chen, B. S., Wicks, J., Bruce, B. B., Meyer, B. I., Dattilo, M., Kedar, S., Saindane, A., Newman, N. J., & Biousse, V. (2023). Presumptive Idiopathic Intracranial Hypertension Based on Neuroimaging Findings: A Referral Pattern Study. Journal of Neuro-Ophthalmology: The Official Journal of the North American Neuro-Ophthalmology Society, 43(1), 55–62. https://doi.org/10.1097/WNO.0000000000001660
Bidot, S., Saindane, A. M., Peragallo, J. H., Bruce, B. B., Newman, N. J., & Biousse, V. (2015). Brain Imaging in Idiopathic Intracranial Hypertension. Journal of Neuro-Ophthalmology: The Official Journal of the North American Neuro-Ophthalmology Society, 35(4), 400–411. https://doi.org/10.1097/WNO.0000000000000303
Bruce, B. B., Kedar, S., Van Stavern, G. P., Monaghan, D., Acierno, M. D., Braswell, R. A., Preechawat, P., Corbett, J. J., Newman, N. J., & Biousse, V. (2009). Idiopathic intracranial hypertension in men. Neurology, 72(4), 304–309. https://doi.org/10.1212/01.wnl.0000333254.84120.f5
Canac, N., Jalaleddini, K., Thorpe, S. G., Thibeault, C. M., & Hamilton, R. B. (2020). Review: Pathophysiology of intracranial hypertension and noninvasive intracranial pressure monitoring. Fluids and Barriers of the CNS, 17(1), 40. https://doi.org/10.1186/s12987-020-00201-8
Celebisoy, N., Gökçay, F., Sirin, H., & Akyürekli, O. (2007). Treatment of idiopathic intracranial hypertension: Topiramate vs acetazolamide, an open-label study. Acta Neurologica Scandinavica, 116(5), 322–327. https://doi.org/10.1111/j.1600-0404.2007.00905.x
Chen, B. S., Meyer, B. I., Saindane, A. M., Bruce, B. B., Newman, N. J., & Biousse, V. (2021). Prevalence of Incidentally Detected Signs of Intracranial Hypertension on Magnetic Resonance Imaging and Their Association With Papilledema. JAMA Neurology, 78(6), 718–725. https://doi.org/10.1001/jamaneurol.2021.0710
Csj, W., K, M., Jl, M., A, Y., R, S., P, S., Jw, T., Gg, L., Sp, M., & Aj, S. (2022). Increased systemic and adipose 11β-HSD1 activity in idiopathic intracranial hypertension. European Journal of Endocrinology, 187(2). https://doi.org/10.1530/EJE-22-0108
Dandy, W. E. (1937). INTRACRANIAL PRESSURE WITHOUT BRAIN TUMOR: DIAGNOSIS AND TREATMENT. Annals of Surgery, 106(4), 492–513. https://doi.org/10.1097/00000658-193710000-00002
Daniels, A. B., Liu, G. T., Volpe, N. J., Galetta, S. L., Moster, M. L., Newman, N. J., Biousse, V., Lee, A. G., Wall, M., Kardon, R., Acierno, M. D., Corbett, J. J., Maguire, M. G., & Balcer, L. J. (2007). Profiles of obesity, weight gain, and quality of life in idiopathic intracranial hypertension (pseudotumor cerebri). American Journal of Ophthalmology, 143(4), 635–641. https://doi.org/10.1016/j.ajo.2006.12.040
Dhungana, S., Sharrack, B., & Woodroofe, N. (2009). Cytokines and chemokines in idiopathic intracranial hypertension. Headache, 49(2), 282–285. https://doi.org/10.1111/j.1526-4610.2008.001329.x
Eide, P. K., Pripp, A. H., Ringstad, G., & Valnes, L. M. (2021). Impaired glymphatic function in idiopathic intracranial hypertension. Brain Communications, 3(2), fcab043. https://doi.org/10.1093/braincomms/fcab043
Fahmy, E. M., Rashed, L. A., Mostafa, R. H., & Ismail, R. S. (2021). Role of tumor necrosis factor-alpha in the pathophysiology of idiopathic intracranial hypertension. Acta Neurologica Scandinavica, 144(5), 509–516. https://doi.org/10.1111/ane.13482
Farb, R. I., Vanek, I., Scott, J. N., Mikulis, D. J., Willinsky, R. A., Tomlinson, G., & terBrugge, K. G. (2003). Idiopathic intracranial hypertension: The prevalence and morphology of sinovenous stenosis. Neurology, 60(9), 1418–1424. https://doi.org/10.1212/01.wnl.0000066683.34093.e2
Fargen, K. M., Coffman, S., Torosian, T., Brinjikji, W., Nye, B. L., & Hui, F. (2023). “Idiopathic” intracranial hypertension: An update from neurointerventional research for clinicians. Cephalalgia: An International Journal of Headache, 43(4), 3331024231161323. https://doi.org/10.1177/03331024231161323
Fisayo, A., Bruce, B. B., Newman, N. J., & Biousse, V. (2016). Overdiagnosis of idiopathic intracranial hypertension. Neurology, 86(4), 341–350. https://doi.org/10.1212/WNL.0000000000002318
Gn, P., Sn, D., & Ga, T. (2007). Octreotide: A therapeutic option for idiopathic intracranial hypertension. https://pubmed.ncbi.nlm.nih.gov/17700925/
Grech, O., Seneviratne, S. Y., Alimajstorovic, Z., Yiangou, A., Mitchell, J. L., Smith, T. B., Mollan, S. P., Lavery, G. G., Ludwig, C., & Sinclair, A. J. (2022). Nuclear Magnetic Resonance Spectroscopy Metabolomics in Idiopathic Intracranial Hypertension to Identify Markers of Disease and Headache. Neurology, 99(16), e1702–e1714. https://doi.org/10.1212/WNL.0000000000201007
Hardy, R. S., Botfield, H., Markey, K., Mitchell, J. L., Alimajstorovic, Z., Westgate, C. S. J., Sagmeister, M., Fairclough, R. J., Ottridge, R. S., Yiangou, A., Storbeck, K.-H. H., Taylor, A. E., Gilligan, L. C., Arlt, W., Stewart, P. M., Tomlinson, J. W., Mollan, S. P., Lavery, G. G., & Sinclair, A. J. (2021). 11βHSD1 Inhibition with AZD4017 Improves Lipid Profiles and Lean Muscle Mass in Idiopathic Intracranial Hypertension. The Journal of Clinical Endocrinology and Metabolism, 106(1), 174–187. https://doi.org/10.1210/clinem/dgaa766
Horev, A., Hallevy, H., Plakht, Y., Shorer, Z., Wirguin, I., & Shelef, I. (2013). Changes in cerebral venous sinuses diameter after lumbar puncture in idiopathic intracranial hypertension: A prospective MRI study. Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging, 23(3), 375–378. https://doi.org/10.1111/j.1552-6569.2012.00732.x
Hornby, C., Mollan, S. P., Botfield, H., OʼReilly, M. W., & Sinclair, A. J. (2018). Metabolic Concepts in Idiopathic Intracranial Hypertension and Their Potential for Therapeutic Intervention. Journal of Neuro-Ophthalmology: The Official Journal of the North American Neuro-Ophthalmology Society, 38(4), 522–530. https://doi.org/10.1097/WNO.0000000000000684
Kaipainen, A. L., Martoma, E., Puustinen, T., Tervonen, J., Jyrkkänen, H.-K., Paterno, J. J., Kotkansalo, A., Rantala, S., Vanhanen, U., Leinonen, V., Lehto, S. M., Iso-Mustajärvi, M., Elomaa, A.-P., Qvarlander, S., & Huuskonen, T. J. (2021). Cerebrospinal fluid dynamics in idiopathic intracranial hypertension: A literature review and validation of contemporary findings. Acta Neurochirurgica, 163(12), 3353–3368. https://doi.org/10.1007/s00701-021-04940-x
Kalyvas, A., Neromyliotis, E., Koutsarnakis, C., Komaitis, S., Drosos, E., Skandalakis, G. P., Pantazi, M., Gobin, Y. P., Stranjalis, G., & Patsalides, A. (2021). A systematic review of surgical treatments of idiopathic intracranial hypertension (IIH). Neurosurgical Review, 44(2), 773–792. https://doi.org/10.1007/s10143-020-01288-1
Kesler, A., Kliper, E., Shenkerman, G., & Stern, N. (2010). Idiopathic intracranial hypertension is associated with lower body adiposity. Ophthalmology, 117(1), 169–174. https://doi.org/10.1016/j.ophtha.2009.06.030
Ko, M. W., Chang, S. C., Ridha, M. A., Ney, J. J., Ali, T. F., Friedman, D. I., Mejico, L. J., Volpe, N. J., Galetta, S. L., Balcer, L. J., & Liu, G. T. (2011). Weight gain and recurrence in idiopathic intracranial hypertension: A case-control study. Neurology, 76(18), 1564–1567. https://doi.org/10.1212/WNL.0b013e3182190f51
Krajnc, N., Itariu, B., Macher, S., Marik, W., Harreiter, J., Michl, M., Novak, K., Wöber, C., Pemp, B., & Bsteh, G. (2023). Treatment with GLP-1 receptor agonists is associated with significant weight loss and favorable headache outcomes in idiopathic intracranial hypertension. The Journal of Headache and Pain, 24(1), 89. https://doi.org/10.1186/s10194-023-01631-z
Kwaśniak-Butowska, M., Muraszko-Klaudel, A., & Sławek, J. (2016). Idiopatyczne nadciśnienie śródczaszkowe—Obraz kliniczny, diagnostyka i leczenie. Polski Przegląd Neurologiczny, 12(2), Article 2. https://journals.viamedica.pl/polski_przeglad_neurologiczny/article/view/48571/37746
Lowe, M., Berman, G., Sumithran, P., & Mollan, S. P. (2025). Current Understanding of the Pathophysiology of Idiopathic Intracranial Hypertension. Current Neurology and Neuroscience Reports, 25(1), 31. https://doi.org/10.1007/s11910-025-01420-y
Markey, K., Mitchell, J., Botfield, H., Ottridge, R. S., Matthews, T., Krishnan, A., Woolley, R., Westgate, C., Yiangou, A., Alimajstorovic, Z., Shah, P., Rick, C., Ives, N., Taylor, A. E., Gilligan, L. C., Jenkinson, C., Arlt, W., Scotton, W., Fairclough, R. J., … Sinclair, A. J. (2020). 11β-Hydroxysteroid dehydrogenase type 1 inhibition in idiopathic intracranial hypertension: A double-blind randomized controlled trial. Brain Communications, 2(1), fcz050. https://doi.org/10.1093/braincomms/fcz050
Mollan, S. P., Davies, B., Silver, N. C., Shaw, S., Mallucci, C. L., Wakerley, B. R., Krishnan, A., Chavda, S. V., Ramalingam, S., Edwards, J., Hemmings, K., Williamson, M., Burdon, M. A., Hassan-Smith, G., Digre, K., Liu, G. T., Jensen, R. H., & Sinclair, A. J. (2018). Idiopathic intracranial hypertension: Consensus guidelines on management. Journal of Neurology, Neurosurgery, and Psychiatry, 89(10), 1088–1100. https://doi.org/10.1136/jnnp-2017-317440
Mollan, S. P., Grech, O., & Sinclair, A. J. (2021). Headache attributed to idiopathic intracranial hypertension and persistent post-idiopathic intracranial hypertension headache: A narrative review. Headache, 61(6), 808–816. https://doi.org/10.1111/head.14125
Mollan, S. P., Mitchell, J. L., Ottridge, R. S., Aguiar, M., Yiangou, A., Alimajstorovic, Z., Cartwright, D. M., Grech, O., Lavery, G. G., Westgate, C. S. J., Vijay, V., Scotton, W., Wakerley, B. R., Matthews, T. D., Ansons, A., Hickman, S. J., Benzimra, J., Rick, C., Singhal, R., … Sinclair, A. J. (2021). Effectiveness of Bariatric Surgery vs Community Weight Management Intervention for the Treatment of Idiopathic Intracranial Hypertension: A Randomized Clinical Trial. JAMA Neurology, 78(6), 678–686. https://doi.org/10.1001/jamaneurol.2021.0659
Mollan, S. P., Mitchell, J. L., Yiangou, A., Ottridge, R. S., Alimajstorovic, Z., Cartwright, D. M., Hickman, S. J., Markey, K. A., Singhal, R., Tahrani, A. A., Frew, E., Brock, K., & Sinclair, A. J. (2022). Association of Amount of Weight Lost After Bariatric Surgery With Intracranial Pressure in Women With Idiopathic Intracranial Hypertension. Neurology, 99(11), e1090–e1099. https://doi.org/10.1212/WNL.0000000000200839
NORDIC Idiopathic Intracranial Hypertension Study Group Writing Committee, Wall, M., McDermott, M. P., Kieburtz, K. D., Corbett, J. J., Feldon, S. E., Friedman, D. I., Katz, D. M., Keltner, J. L., Schron, E. B., & Kupersmith, M. J. (2014). Effect of acetazolamide on visual function in patients with idiopathic intracranial hypertension and mild visual loss: The idiopathic intracranial hypertension treatment trial. JAMA, 311(16), 1641–1651. https://doi.org/10.1001/jama.2014.3312
O’Reilly, M. W., Westgate, C. S., Hornby, C., Botfield, H., Taylor, A. E., Markey, K., Mitchell, J. L., Scotton, W. J., Mollan, S. P., Yiangou, A., Jenkinson, C., Gilligan, L. C., Sherlock, M., Gibney, J., Tomlinson, J. W., Lavery, G. G., Hodson, D. J., Arlt, W., & Sinclair, A. J. (2019). A unique androgen excess signature in idiopathic intracranial hypertension is linked to cerebrospinal fluid dynamics. JCI Insight, 4(6), e125348, 125348. https://doi.org/10.1172/jci.insight.125348
(PDF) Evaluation of cerebrospinal fluid flow dynamic changes in patients with idiopathic intracranial hypertension using phase contrast cine MR imaging. (2024). ResearchGate. https://doi.org/10.1186/s41983-020-00227-7
Raoof, N., Sharrack, B., Pepper, I. M., & Hickman, S. J. (2011). The incidence and prevalence of idiopathic intracranial hypertension in Sheffield, UK. European Journal of Neurology, 18(10), 1266–1268. https://doi.org/10.1111/j.1468-1331.2011.03372.x
Samancı, B., Samancı, Y., Tüzün, E., Altıokka-Uzun, G., Ekizoğlu, E., İçöz, S., Şahin, E., Küçükali, C. İ., & Baykan, B. (2017). Evidence for potential involvement of pro-inflammatory adipokines in the pathogenesis of idiopathic intracranial hypertension. Cephalalgia: An International Journal of Headache, 37(6), 525–531. https://doi.org/10.1177/0333102416650705
Sinclair, A. J., Burdon, M. A., Nightingale, P. G., Ball, A. K., Good, P., Matthews, T. D., Jacks, A., Lawden, M., Clarke, C. E., Stewart, P. M., Walker, E. A., Tomlinson, J. W., & Rauz, S. (2010). Low energy diet and intracranial pressure in women with idiopathic intracranial hypertension: Prospective cohort study. BMJ, 341, c2701. https://doi.org/10.1136/bmj.c2701
Sinclair, A. J., Onyimba, C. U., Khosla, P., Vijapurapu, N., Tomlinson, J. W., Burdon, M. A., Stewart, P. M., Murray, P. I., Walker, E. A., & Rauz, S. (2007). Corticosteroids, 11beta-hydroxysteroid dehydrogenase isozymes and the rabbit choroid plexus. Journal of Neuroendocrinology, 19(8), 614–620. https://doi.org/10.1111/j.1365-2826.2007.01569.x
Thaller, M., Mytton, J., Wakerley, B. R., Mollan, S. P., & Sinclair, A. J. (2022). Idiopathic intracranial hypertension: Evaluation of births and fertility through the Hospital Episode Statistics dataset. BJOG: An International Journal of Obstetrics and Gynaecology, 129(12), 2019–2027. https://doi.org/10.1111/1471-0528.17241
Thaller, M., Sinclair, A. J., Tsermoulas, G., & Mollan, S. P. (2023). Considerations from venous stenosis to metabolic underpinnings in Idiopathic Intracranial Hypertension. Cephalalgia: An International Journal of Headache, 43(6), 3331024231184445. https://doi.org/10.1177/03331024231184445
Vosoughi, A. R., Margolin, E. A., & Micieli, J. A. (2022). Idiopathic Intracranial Hypertension: Incidental Discovery Versus Symptomatic Presentation. Journal of Neuro-Ophthalmology: The Official Journal of the North American Neuro-Ophthalmology Society, 42(2), 187–191. https://doi.org/10.1097/WNO.0000000000001475
Wardman, J. H., Andreassen, S. N., Toft-Bertelsen, T. L., Jensen, M. N., Wilhjelm, J. E., Styrishave, B., Hamann, S., Heegaard, S., Sinclair, A. J., & MacAulay, N. (2024). CSF hyperdynamics in rats mimicking the obesity and androgen excess characteristic of patients with idiopathic intracranial hypertension. Fluids and Barriers of the CNS, 21(1), 10. https://doi.org/10.1186/s12987-024-00511-1
Westgate, C. S., Botfield, H. F., Alimajstorovic, Z., Yiangou, A., Walsh, M., Smith, G., Singhal, R., Mitchell, J. L., Grech, O., Markey, K. A., Hebenstreit, D., Tennant, D. A., Tomlinson, J. W., Mollan, S. P., Ludwig, C., Akerman, I., Lavery, G. G., & Sinclair, A. J. (2021). Systemic and adipocyte transcriptional and metabolic dysregulation in idiopathic intracranial hypertension. JCI Insight, 6(10), e145346, 145346. https://doi.org/10.1172/jci.insight.145346
Westgate, C. S. J., Hagen, S. M., Israelsen, I. M. E., Hamann, S., Jensen, R. H., & Eftekhari, S. (2022). The impact of obesity-related raised intracranial pressure in rodents. Scientific Reports, 12(1), 9102. https://doi.org/10.1038/s41598-022-13181-6
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Angelika Macko, Bartosz Łuniewski, Maria Łuniewska, Adam Rafałowicz, Monika Olszanska, Kamil Klaudiusz Lauko, Iga Maria Nowicka, Urszula Justyna Wojciechowska

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 247
Number of citations: 0