Treatment may be indicated in the following situations: severe/intractable headache, evidence of progressive decrease in visual acuity or visual field loss. Some ophthalmologists suggest treating all patients with papilledema.
Weight loss
Acetazolamide 250mg QID (or 500mg BID) initially building up to 500-1000mg QID if tolerated. Use with caution in sulfa-allergic patients. (decreases CSF production)
Discontinue any causative medications
Short course of systemic steroids, especially if any plans for surgical intervention
Repeat LPs (decrease CSF pressure) - large volume LPs on the order of 30-40 cc of CSF
Furosemide 20mg PO BID, give potassium supp as needed
If above treatments are unsuccessful, surgical treatments may be considered.
CSF Shunt (ventriculoperitoneal or lumboperitoneal) is often effective if vision is threatened
Optic nerve sheath fenestration
CSF Shunt (ventriculoperitoneal or lumboperitoneal) is often effective if vision is threatened
Optic nerve sheath fenestration
Idiopathic intracranial hypertension
Migraine headache
Subarachnoid hemorrhage
Tension headache
Post-lumbar puncture headache
Cluster headache
Subdural hemorrhage
Meningitis/encephalitis