Background
The mechanisms driving headache in Idiopathic Intracranial Hypertension (IIH) are not fully understood. Headache is the dominant driver for disability and typically has migraine-like characteristics. There are currently no evidence-based therapeutics for headache in IIH, and consequently this is an important unmet need.
Case series
We report seven patients with confirmed IIH who initially presented with increased headache driven by raised intracranial pressure (ICP). The headaches had migraine-like characteristics which persisted despite resolution of papilloedema (ocular remission). These headaches responded markedly to Erenumab, a monoclonal antibody targeted against the calcitonin gene related peptide (CGRP) receptor. Importantly, there was a recurrence of raised ICP and papilloedema, however headaches did not recur whilst treated with Erenumab.
Conclusions
These cases suggest that CGRP could be a mechanistic driver for headache in patients with active IIH. Clinical trials evaluating safety and efficacy of CGRP monoclonal antibodies in active IIH would be of interest.