7.1.1 Headache attributed to idiopathic intracranial hypertension (IIH)

Identification: Sex/Age: Female, 24 years BMI: 38 kg/m² (obesity grade II) History: Polycystic ovary syndrome Use of combined oral contraceptive for 4 years Family history: Mother with idiopathic intracranial hypertension History of Present Illness (HPI): Main symptom: Daily headache for 6 weeks Characteristics: Location: Holocranial (predominantly occipital) Character: Pulsatile and constant Intensity: 8/10 Chronology: Progressive worsening, more intense upon waking Triggering/aggravating factors: Cough, neck flexion, and physical exertion Relieving factors: Sitting position Associated symptoms: Transient visual obscurations (30 seconds duration, 2-3x/day) Photophobia and phonophobia Pulsatile tinnitus synchronous with heartbeat Occasional nausea (without vomiting) Physical/Neurological Examination: General: Marked central obesity Neurological: Fundoscopy: Bilateral grade III papilledema Ocular motility: Partial bilateral sixth cranial nerve palsy Other findings: Normal reflexes, preserved muscle strength Vital signs: BP 118/76 mmHg, HR 82 bpm Complementary Exams: Magnetic Resonance Imaging of the Brain: Collapsed ventricles Pituitary adherence to the sella turcica (partial "empty sella") Absence of expansive lesions or malformations MR Venography: Exclusion of cerebral venous thrombosis Lumbar Puncture: Opening pressure: 36 cmH₂O Clear cerebrospinal fluid, normal analysis