Losing weight can significantly reduce intracranial pressure and the complications it causes, including headache and optic nerve anomalies.1 “This is the first study to conclusively show that weight loss is effective at reducing intracranial pressure and headaches in patients with idiopathic intracranial hypertension,” said study author Alexandra Sinclair, MD, of the University of Birmingham, Birmingham, UK.
Idiopathic intracranial hypertension, which predominantly affects obese women, can cause vision loss and disabling headaches. With the global epidemic of obesity, the prevalence of the condition is growing. The primary treatment is weight loss, according to Dr Sinclair, “but the effectiveness of losing weight has never been tested in a prospective trial. The only published trial of weight loss dates to the 1970s, in 9 patients.”
To place this therapy on a firmer footing, Dr Sinclair and colleagues enrolled 25 women, aged 19 to 54, with a mean body mass index of 37.4 and disease duration between 4 and 189 months. For the first 3 months, patients underwent observation without intervention, and then for the next 3 months ate a highly calorie-restricted diet.
No patient’s condition improved during the observational period on any of the outcome measures of intracranial pressure, headache, optic nerve parameters, or visual function. In contrast, when patients lost weight (mean, 15.2 kg), reducing their body mass index by 14%, their intracranial pressure dropped by 21% (from 39.5 cm H2O to 31.3 cm H2O). In addition, headache impact improved significantly, as did optic disk elevation and nerve sheath diameter. There was no change in visual field or acuity measures, but other symptoms—diplopia, tinnitus, and vision loss—did improve.
Weight loss is difficult to maintain, Dr Sinclair noted, and there is no reason to suspect that pressures will stay low in patients who regain their weight. Therefore, a weight loss program designed for long-term weight management is important for maintaining benefit.
1. Sinclair A, Burdon M, Ball A, et al. Prospective evaluation of weight loss in intracranial pressure in idiopathic intracranial hypertension [LB2.003]. Poster presentation, April 29, 2009.