Epidemiology, pharmacological treatment and invasive management of idiopathic intracranial hypertension in Austria: a nationwide, hospital-based, controlled analysis of insurance data.

QUESTION/

OBJECTIVE

Idiopathic intracranial hypertension (IIH) is a rare disorder characterized by headaches and papilledema. In this nationwide, hospital-based, controlled analysis of insurance data, we aimed at investigating IIH prevalence and treatment patterns.

METHODS

The Austrian health insurance register was queried for patients discharged between 2016 and 2021 with an ICD-10 diagnosis of G93.2 and/or prescription of acetazolamide (AZM). Study inclusion required both ≥ 2 assignments of G93.2 and ≥ 1 dispensation of AZM. For each IIH patient, age- and sex-matched obese controls (OBC, ICD-10: E65/66/68) and general population controls (GPC) were drawn. We then extracted all medication collected and procedures performed during the study period.

RESULTS

Of 5,969 patients identified, 114 met the inclusion criteria, yielding an estimated hospital-based IIH prevalence of 4.77 per 100,000 discharges in total and 7.88 per 100,000 female discharges. IIH patients had the highest rates of AZM (100% vs. 0% vs. 0%), topiramate (39.5% vs. 2.6% vs. 0.9%), furosemide (18.4% vs. 5.3% vs. 0.9%), lumbar puncture (11.4% vs. 0% vs. 0%), and ventriculoperitoneal shunting (18.4% vs. 0% vs. 0%) compared with OBC and GPC. In contrast, bariatric surgery was less common in IIH than in OBC (4.4% vs. 31.6%; 0% in GPC).

CONCLUSIONS

The estimated prevalence falls within reported ranges for Central Europe while likely underestimating the prevalence due to reliance on hospital discharge data. Treatment patterns generally reflect guideline-based management, although invasive procedures appear overrepresented because hospital data skew towards severe cases. Bariatric surgery is underutilized in patients with IIH compared to those with obesity alone.