What are the recommended first-line treatment options for managing idiopathic intracranial hypertension?

First-line treatment options for managing idiopathic intracranial hypertension (IIH) primarily focus on reducing intracranial pressure and preserving vision. The UK clinical guidelines emphasize the importance of weight management as a foundational approach, given the strong association between obesity and IIH.

Pharmacologically, acetazolamide, a carbonic anhydrase inhibitor, is commonly recommended as the first-line medical treatment to reduce cerebrospinal fluid production and lower intracranial pressure.

Topiramate, another carbonic anhydrase inhibitor with additional migraine prophylactic properties, has been considered as an alternative or adjunctive therapy; recent literature suggests it may be effective as initial therapy, but this is not yet established as standard first-line treatment in UK guidelines.

In cases where medical management is insufficient or vision is threatened, referral to specialist neurology or ophthalmology services for further interventions, including surgical options, is advised.

Overall, the initial management in primary care involves lifestyle modification focusing on weight loss and the initiation of acetazolamide, with consideration of topiramate based on specialist advice and emerging evidence.

References: ¹ (Goyal and Zarroli, 2023)