IIH is monitored closely through outpatient examinations, which
include regular visual testing. Headache diaries are helpful in
monitoring. If an underlying cause of IIH is identified, its
treatment will usually control IIH. Excess weight will need
addressing and loosing seven to ten per cent of body weight may
improve headaches and vision. Weight loss should be achieved
through a dietician-lead calorie-controlled diet plus exercise.
When there is no clear cause, IIH can be treated through lumbar
punctures, medicines or surgery.
Lumbar puncture involves draining CSF from the lower back, thus
reducing ICP. A lumbar puncture is performed under local or general
anaesthetic, usually general anaesthetic for children. Intermittent
lumbar puncture to reduce pressure is usually an effective
treatment for IIH.
Treatment with acetazolamide reduces CSF production and thus
reduces ICP. Other dehydrating medicines, such as furosemide, can
be tried but are less effective. Steroids can also be tried as
When lumbar puncture or drug therapies are unsuccessful or when
vision is deteriorating, surgical treatment will be considered.
Shunts (a tube draining CSF from the brain or spine into the
abdomen) can be used to reduce ICP and there are many different
types available. A subtemporal decompression, a technique whereby a
'window' is made in the side of the skull thus reducing ICP, can
also be performed. Optic nerve fenestration or decompression is
another surgical option. In this procedure, slits or a large hole
are placed in the optic nerve sheath and fluid drains out, thereby
taking pressure off the optic nerve and preventing sight loss.