{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T06:03:02Z","timestamp":1789624982143,"version":"build-2803163510"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100022025","name":"South Valley University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100022025","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>The application of Friedman\u2019s criteria to diagnose suggested IIH WOP will prevent many chronic patients with migraine (CM) from proper diagnosis and treatment. Our prospective study aimed to compare the prevalence of suggested IIH WOP in case of following Friedman\u2019s criteria and in case of novel proposed criteria (OP\u2009&gt;\u2009200 mmH2O and radiological finding\u2009\u2265\u2009two), also reporting the predictive radiological signs for IIH WOP. Refractory chronic patients with migraine underwent ophthalmologic, neurological evaluation, MRI, and a lumbar puncture (LP) with opening pressure (OP) measurement. CSF withdrawal was performed in patients with CSF OP\u2009&gt;\u2009200 mmH20. Suggested IIHWOP was defined according to Friedman\u2019s criteria and our novel criteria. Regression analysis was performed to detect the strongest predictor of suggested IIHWOP. The effect of CSF withdrawal was evaluated clinically after two months. One hundred and two consecutive CM were enrolled (95\u00a0F, age 32.34\u2009\u00b1\u20099.45, and BMI 29.04\u2009\u00b1\u20095.89) without papilledema. Eighteen patients (17.65%) had OP greater than 250 mmH2O, and 20 patients (19.61%) with OP\u2009\u2265\u2009200 mmH2O and \u2264\u2009250 mH2O. Prevalence of suggested IIH WOP, according to Friedman\u2019s diagnostic criteria, was three patients (2.9%) only. In case of our novel diagnostic criteria (Absent 6th nerve palsy, ICP\u2009&gt;\u2009200 mmH2O, and \u2265\u2009two radiological signs), eight patients (7.8%) were discovered. After CSF withdrawal, 85% of patients with migraine with OP\u2009&gt;\u2009200\u00a0mm H2O improved, specially CM with bilateral Transverse sinus stenosis (TSS). The prevalence of suggested IIH WOP in CM was 7.8%. Bilateral TSS was the only predictor of IIHWOP.<\/jats:p>","DOI":"10.1038\/s41598-025-14758-7","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T16:00:16Z","timestamp":1755878416000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Idiopathic intracranial hypertension without papilledema in chronic migraineurs and revisiting of friedman\u2019s diagnostic criteria"],"prefix":"10.1038","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3092-2159","authenticated-orcid":false,"given":"Islam El","family":"Malky","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wael Elshazly","family":"Aita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazem","family":"Abdelkhalek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr M.","family":"Tayel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Abdelhafiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,22]]},"reference":[{"issue":"1","key":"14758_CR1","doi-asserted-by":"publisher","first-page":"1788","DOI":"10.1038\/s41598-024-85033-4","volume":"15","author":"IE Malky","year":"2025","unstructured":"Malky, I. E. et al. Optic nerve sonographic parameters in idiopathic intracranial hypertension, case-control study. Sci. Rep. 15 (1), 1788 (2025).","journal-title":"Sci. Rep."},{"issue":"11","key":"14758_CR2","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1007\/s11916-023-01166-7","volume":"27","author":"S Sengupta","year":"2023","unstructured":"Sengupta, S. & Vidwan, J. Overlap and differences in migraine and idiopathic intracranial hypertension. Curr. Pain Headache Rep. 27 (11), 653\u2013662 (2023).","journal-title":"Curr. Pain Headache Rep."},{"issue":"7","key":"14758_CR3","doi-asserted-by":"publisher","first-page":"1365","DOI":"10.1007\/s00415-014-7355-2","volume":"261","author":"R De Simone","year":"2014","unstructured":"De Simone, R. et al. Intracranial pressure in unresponsive chronic migraine. J. Neurol. 261 (7), 1365\u20131373 (2014).","journal-title":"J. Neurol."},{"issue":"6","key":"14758_CR4","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1111\/j.1468-2982.2008.01564.x","volume":"28","author":"DS Vieira","year":"2008","unstructured":"Vieira, D. S. et al. Idiopathic intracranial hypertension with and without papilloedema in a consecutive series of patients with chronic migraine. Cephalalgia 28 (6), 609\u2013613 (2008).","journal-title":"Cephalalgia"},{"key":"14758_CR5","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1001\/jamaneurol.2019.1696","volume":"76","author":"S Sengupta","year":"2019","unstructured":"Sengupta, S., Eckstein, C. & Collins, T. The dilemma of diagnosing idiopathic intracranial hypertension without papilledema in patients with chronic migraine. JAMA Neurol. 76, 1001 (2019).","journal-title":"JAMA Neurol."},{"issue":"5","key":"14758_CR6","doi-asserted-by":"publisher","first-page":"1226","DOI":"10.1212\/WNL.46.5.1226","volume":"46","author":"NT Mathew","year":"1996","unstructured":"Mathew, N. T., Ravishankar, K. & Sanin, L. C. Coexistence of migraine and idiopathic intracranial hypertension without papilledema. Neurology 46 (5), 1226\u20131230 (1996).","journal-title":"Neurology"},{"issue":"12","key":"14758_CR7","doi-asserted-by":"publisher","first-page":"1419","DOI":"10.1177\/0333102410370877","volume":"30","author":"F Bono","year":"2010","unstructured":"Bono, F. et al. Abnormal pressure waves in headache sufferers with bilateral transverse sinus stenosis. Cephalalgia 30 (12), 1419\u20131425 (2010).","journal-title":"Cephalalgia"},{"key":"14758_CR8","doi-asserted-by":"publisher","first-page":"899","DOI":"10.3389\/fneur.2019.00899","volume":"10","author":"F Wang","year":"2019","unstructured":"Wang, F. et al. Population-based evaluation of lumbar puncture opening pressures. Front. Neurol. 10, 899 (2019).","journal-title":"Front. Neurol."},{"issue":"13","key":"14758_CR9","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1212\/WNL.0b013e3182a55f17","volume":"81","author":"DI Friedman","year":"2013","unstructured":"Friedman, D. I., Liu, G. T. & Digre, K. B. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 81 (13), 1159\u20131165 (2013).","journal-title":"Neurology"},{"issue":"9","key":"14758_CR10","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1177\/0333102420919098","volume":"40","author":"PJ - Goadsby","year":"2020","unstructured":"Goadsby, P. J. & Evers, S. International classification of headache disorders-ICHD-4 alpha. Cephalalgia 40 (9), 887\u2013888 (2020).","journal-title":"Cephalalgia"},{"issue":"8","key":"14758_CR11","doi-asserted-by":"publisher","first-page":"033310242311971","DOI":"10.1177\/03331024231197118","volume":"43","author":"SP Mollan","year":"2023","unstructured":"Mollan, S. P. et al. Guidelines of the international headache society for controlled clinical trials in idiopathic intracranial hypertension. Cephalalgia 43 (8), 03331024231197118 (2023).","journal-title":"Cephalalgia"},{"issue":"5","key":"14758_CR12","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1212\/01.wnl.0000252808.97649.21","volume":"68","author":"RB Lipton","year":"2007","unstructured":"Lipton, R. B. et al. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 68 (5), 343\u2013349 (2007).","journal-title":"Neurology"},{"issue":"1","key":"14758_CR13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s10194-015-0510-z","volume":"16","author":"R Ornello","year":"2015","unstructured":"Ornello, R. et al. Migraine and body mass index categories: a systematic review and meta-analysis of observational studies. J. Headache Pain. 16 (1), 1\u20134 (2015).","journal-title":"J. Headache Pain"},{"key":"14758_CR14","doi-asserted-by":"publisher","first-page":"503","DOI":"10.3389\/fneur.2018.00503","volume":"9","author":"V Favoni","year":"2018","unstructured":"Favoni, V. et al. Idiopathic intracranial hypertension without papilledema (IIHWOP) in chronic refractory headache. Front. Neurol. 9, 503 (2018).","journal-title":"Front. Neurol."},{"key":"14758_CR15","doi-asserted-by":"publisher","first-page":"1305972","DOI":"10.3389\/fneur.2023.1305972","volume":"14","author":"JP Midtlien","year":"2024","unstructured":"Midtlien, J. P. et al. Characterizing a new clinical phenotype: the co-existence of cerebral venous outflow and connective tissue disorders. Front. Neurol. 14, 1305972 (2024).","journal-title":"Front. Neurol."},{"key":"14758_CR16","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1007\/s10072-019-03775-w","volume":"40","author":"R De Simone","year":"2019","unstructured":"De Simone, R. et al. Dural sinus collapsibility, idiopathic intracranial hypertension, and the pathogenesis of chronic migraine. Neurol. Sci. 40, 59\u201370 (2019).","journal-title":"Neurol. Sci."},{"issue":"6","key":"14758_CR17","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1177\/0333102411399350","volume":"31","author":"R De Simone","year":"2011","unstructured":"De Simone, R., Ranieri, A., Cardillo, G. & Bonavita, V. High prevalence of bilateral transverse sinus stenosis-associate IIHWOP in unresponsive chronic headache sufferers: pathogenetic implications in primary headache progression. Cephalalgia 31 (6), 763\u2013765 (2011).","journal-title":"Cephalalgia"},{"issue":"3","key":"14758_CR18","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1007\/s11916-012-0254-2","volume":"16","author":"R De Simone","year":"2012","unstructured":"De Simone, R., Ranieri, A., Montella, S., Marchese, M. & Bonavita, V. Sinus venous stenosis-associated idiopathic intracranial hypertension without papilledema as a powerful risk factor for progression and refractoriness of headache. Curr. Pain Headache Rep. 16 (3), 261\u2013269 (2012).","journal-title":"Curr. Pain Headache Rep."},{"issue":"1","key":"14758_CR19","doi-asserted-by":"publisher","first-page":"345","DOI":"10.21608\/svuijm.2023.227352.1632","volume":"7","author":"GM Abd-elrazek","year":"2024","unstructured":"Abd-elrazek, G. M., Elmalky, I., Saddiq, A. M. & Abd-el Wahab, S. M. Diagnostic value of MRI and MRV in migraine indicating intracranial hypertension. SVU-International J. Med. Sci. 7 (1), 345\u2013354. https:\/\/doi.org\/10.21608\/svuijm.2023.227352.1632 (2024).","journal-title":"SVU-International J. Med. Sci."},{"key":"14758_CR20","doi-asserted-by":"crossref","unstructured":"Braca, S. et al. Effectiveness and tolerability of liraglutide as add-on treatment in patients with obesity and high\u2010frequency or chronic migraine: A prospective pilot study. Headache: J. Head Face Pain Jun 19. (2025).","DOI":"10.1111\/head.14991"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-14758-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-14758-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-14758-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T11:18:04Z","timestamp":1757416684000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-14758-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,22]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["14758"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-14758-7","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,22]]},"assertion":[{"value":"1 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"approval and consent to participate in the study was approved by Internal review board of Faculty of Medicine, South Valley University (ethical approval number: SVU\/MED\/NAP020\/4\/23\/11\/755).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}],"article-number":"30925"}}