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Idiopathic Intracranial Hypertension

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My wife (34years old)is having severe migraines for 18 days strait. She has been to the ER 3 times this week. They performed an LP to check the spinal fluid pressure which measured 34 1/2. At first the doctor said this was normal but later said it was way to high and that it was too late to remove any fluid. The following day she saw a neurologist who had her go in for an MRI and a CT scan all of which they claim to be "normal". He has prescribed 250 mg of Diamox twice a day and doubled that after last nights visit to the ER. Meanwhile her headache has continued to increase in severity along with numbness in her feet and hands and blotchy vision. It has gotten to the point that on the last 2 visits to the ER the pain meds that she was given had no affect other than making her sleepy. Is there anything else that she can do to relieve her pain?

Category: Neurologist, Medical

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Dr. Sudhir Kumar
Category: Pediatric Neurologist
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Expert:  Dr. Sudhir Kumar
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Hi,

Thank you for posting your query.

Based on her symptoms, the most likely diagnosis is idiopathic or benign intracranial hypertension (known as IIH or BIH), where the CSF pressure is raised. The normal pressure is upto 20, and as your mentioned, it is 34 in her case, which is high.

The treatment for this includes steroids, as well as diamox.

This would lower the pressure, and thus reduce the headaches, and most importantly prevent vision loss.

The fundus of eye should be examined by ophthalmologist to look for papilledema (swelling of optic disc). This would also help in monitoring the treatment response.

About 70% of patients respond to diamox and steroids. Other 30% patients may require a shunt surgery. So bottom-line is that just Migraine treatment won't work and you will need a specific treatment approach . Please discuss this option with your Doctor.

I hope it helps. Please get back if you have any follow up queries.

Best wishes,

Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist,
Institute of Neurosciences,

Dr. Sudhir Kumar
Category: Pediatric Neurologist
Experience: 
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
Dr. Sudhir Kumar and 4 other Medical Specialists are ready to help you

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