Clinical Characteristics, Headache Phenotypes, and Neuroimaging Findings in Idiopathic Intracranial Hypertension: A Single-Center Study

Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure in the absence of secondary causes and is most commonly associated with headache and visual disturbances. The aim of this study was to investigate the demographic and clinical characteristics, headache phenotypes, associated symptoms, and neuroimaging findings of patients with IIH. This retrospective observational study included 80 patients diagnosed with IIH between 2020 and 2025. Clinical information including headache characteristics, associated symptoms, cerebrospinal fluid opening pressure, and magnetic resonance imaging (MRI) findings was obtained from medical records. Migraine-like headache was defined by using the International Classification of Headache Disorders, 3rd edition (ICHD-3). The majority of patients were women (78.8%), and the median age at diagnosis was 38 years. Headache was the most frequent presenting symptom (87.5%), followed by transient visual obscurations (70.0%) and pulsatile tinnitus (46.3%). Migraine-like headache was identified in 37.1% of patients with headache. Typical MRI findings of IIH—including empty or partially empty sella, perioptic subarachnoid space distension, optic nerve tortuosity, and transverse sinus stenosis—were observed at varying frequencies. Acetazolamide was prescribed to all patients, while topiramate was used in approximately one-third; surgical interventions were required in a minority of cases. The findings of this study underscore the heterogeneous clinical presentation of IIH, with substantial overlap between IIH-related and migraine-like headache phenotypes. Recognition of these clinical features, together with supportive neuroimaging findings, may facilitate earlier diagnosis and reduce misclassification with primary headache disorders.