7.1.2 Headache attributed to intracranial hypertension secondary to metabolic, toxic or hormonal cause

Identification: Sex/Age: Female, 19 years

History: History of severe acne treated with oral isotretinoin (40 mg/day) for 3 months

Current medication: Isotretinoin 40 mg/day + vitamin A supplement 25,000 IU/day (self-medication)

Family history: Maternal migraine

History of Present Illness (HPI): Main symptom: Daily headache for 2 weeks

Characteristics:

Location: Holocranial

Character: Constant pressure

Intensity: 6-7/10

Aggravation: Morning and when lying down

Improvement: Orthostatic position

Associated symptoms:

Transient photopsias

Nausea without vomiting

Intermittent horizontal diplopia

Relevant factor: Concomitant use of isotretinoin and megadose of vitamin A

Physical/Neurological Examination: General: Dry skin with cheilitis (side effect of isotretinoin)

Neurological:

Bilateral papilledema (Frisen grade II)

Incomplete paralysis of the right sixth cranial nerve

Remaining examination normal

Meningeal signs: Absent

Complementary Exams: Cranial MRI + venography: No structural changes or venous thrombosis

Lumbar puncture:

ICP = 30 cmH₂O

Clear cerebrospinal fluid, no cytochemical changes

Laboratory:

Serum vitamin A levels: 120 μg/dL (normal values 30-65)

Normal liver and renal function