Is Functional Constipation a Common Comorbidity Associated with Headache Severity in Idiopathic Intracranial Hypertension?
DOI:
https://doi.org/10.58600/eurjther3079Keywords:
case-control study, functional constipation, gut–brain axis, headache severity, idiopathic intracranial hypertensionAbstract
Objective: Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure in the absence of any underlying structural cause. Functional constipation (FC), by increasing intra-abdominal pressure, may influence intracranial pressure dynamics. This study aimed to compare the prevalence of FC in patients with IIH versus healthy controls, and to investigate clinical differences between IIH patients with and without FC.
Methods: This cross-sectional case-control study included 54 patients diagnosed with IIH and 64 healthy controls. FC was assessed according to the Rome IV criteria. Headache severity at presentation was evaluated using the Visual Analog Scale (VAS), and depressive symptoms were measured with the Beck Depression Inventory (BDI). In IIH patients, cerebrospinal fluid (CSF) opening pressure, body mass index (BMI), the presence of papilledema, and peripheral visual field defects were recorded.
Results: The prevalence of FC was significantly higher in the IIH group (53.7%) compared with controls (10.9%) (p<0.001). No significant associations were found between FC and BMI, CSF opening pressure, papilledema, or visual field loss in IIH patients. However, patients with FC had significantly higher VAS scores at presentation (p<0.001). In the regression model including selected clinical variables, higher VAS scores were associated with FC; however, residual confounding cannot be excluded (OR=3.76, 95% CI: 1.85–7.65, p<0.001).
Conclusion: Functional constipation is common in patients with IIH and is associated with greater headache severity. These findings highlight a potential role of the gut–brain axis in IIH pathophysiology, warranting further investigation in future studies.
References
[1] Wang MTM, Bhatti MT, Danesh-Meyer HV (2022) Idiopathic intracranial hypertension: Pathophysiology, diagnosis and management. J Clin Neurosci. 95:172-179. https://doi.org/10.1016/j.jocn.2021.11.029
[2] Markey KA, Mollan SP, Jensen RH, Sinclair AJ (2016) Understanding idiopathic intracranial hypertension: Mechanisms, management, and future directions. Lancet Neurol. 15(1):78-91. https://doi.org/10.1016/S1474-4422(15)00298-7
[3] Raoof N, Hoffmann J (2021) Diagnosis and treatment of idiopathic intracranial hypertension. Cephalalgia. 41(4):472–478. https://doi.org/10.1177/0333102421997093
[4] Rohit W, Rajesh A, Mridula R, Jabeen SA (2021) Idiopathic Intracranial Hypertension - Challenges and Pearls. Neurol India. 69(Suppl 2):S434–S442. https://doi.org/10.4103/0028-3886.332276
[5] O’Donnell MT, Haviland SM (2024) Functional Constipation and Obstructed Defecation. Surg Clin North Am. 104(3):565-578. https://doi.org/10.1016/j.suc.2023.11.007
[6] Aziz I, Whitehead WE, Palsson OS, Törnblom H, Simrén M (2020) An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation. Expert Rev Gastroenterol Hepatol. 14(1):39-46. https://doi.org/10.1080/17474124.2020.1708718
[7] Tekin İB, Öcal S (2023) Fonksiyonel Konstipasyona Güncel Bakış. Güncel Gastroenteroloji. 25(2):124-132.
[8] Barberio B, Judge C, Savarino EV, Ford AC (2021) Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 6(8):638-648. https://doi.org/10.1016/S2468-1253(21)00111-4
[9] Zhang Z, Wang X, Jonas JB, Wang H, Zhang X, Peng X, Ritch R, Tian G, Yang D, Li L, Li J, Wang N (2014) Valsalva manoeuver, intra-ocular pressure, cerebrospinal fluid pressure, optic disc topography: Beijing intracranial and intra-ocular pressure study. Acta Ophthalmol. 92(6):e475-80. https://doi.org/10.1111/AOS.12263
[10] Yiangou A, Weaver SRC, Thaller M, Mitchell JL, Lyons HS, Tsermoulas G, Mollan SP, Lucas Samuel JE, Sinclair AJ (2024) The Impact of Valsalva Manoeuvres and Exercise on Intracranial Pressure and Cerebrovascular Dynamics in Idiopathic Intracranial Hypertension. Neuro-Ophthalmology. 22;48(2):122-133. https://doi.org/10.1080/01658107.2023.2281433
[11] Friedman DI, Jacobson DM (2002) Diagnostic criteria for idiopathic intracranial hypertension. Neurology. 26;59(10):1492-5. https://doi.org/10.1212/01.WNL.0000029570.69134.1B
[12] de Abreu GE, Dourado ER, Alves D de N, de Araujo MQ, Mendonça NSP, Barroso Junior U (2018) Functional constipation and overactive bladder in women: A population-based study. Arq Gastroenterol. 55(Suppl 1):35-40. https://doi.org/10.1590/S0004-2803.201800000-46
[13] Yiangou A, Mollan SP, Sinclair AJ (2023) Idiopathic intracranial hypertension: a step change in understanding the disease mechanisms. Nat Rev Neurol. 19(12):769-785. https://doi.org/10.1038/S41582-023-00893-0
[14] Souza MNP, Costa Barbara AL, Santos F, Fortini I (2022) Update on Idiopathic Intracranial Hypertension Management. Arq Neuropsiquiatr. 80(5 Suppl. 1):227-231. https://doi.org/10.1590/0004-282X-ANP-2022-S110
[15] Wang GN, Zhang K, Xiong YY, Liu S (2023) The relationship between functional constipation and overweight/obesity in children: a systematic review and meta-analysis. Pediatr Res. 94:1878–1886. https://doi.org/10.1038/s41390-023-02711-1
[16] Peppas G, Alexiou VG, Mourtzoukou E, Falagas ME (2008) Epidemiology of constipation in Europe and Oceania: A systematic review. BMC Gastroenterol. 12;8:5. https://doi.org/10.1186/1471-230X-8-5
[17] Martínez-Lage JF, Martos-Tello JM, Ros-de-San Pedro J, Almagro MJ (2008) Severe constipation: An under-appreciated cause of VP shunt malfunction: A case-based update. Child’s Nervous System. 24(4):431-435. https://doi.org/10.1007/S00381-007-0514-3
[18] Morais BA, Cardeal DD, Andrade FG, Paiva WS, Matushita H, Teixeira MJ (2018) Reversible ventriculoperitoneal shunt dysfunction and chronic constipation: case report. J Neurosurg Pediatr. 22(2):147-150. https://doi.org/10.3171/2018.2.PEDS17574
[19] Yri HM, Jensen RH (2015) Idiopathic intracranial hypertension: Clinical nosography and field-testing of the ICHD diagnostic criteria. A case-control study. Cephalalgia. 35(7):553-562. https://doi.org/10.1177/0333102414550109
[20] Liang J, Zhao Y, Xi Y, Xiang C, Yong C, Huo J, Zou H, Hou Y, Pan Y, Wu M, Xie Q, Lin Q (2022) Association between Depression, Anxiety Symptoms and Gut Microbiota in Chinese Elderly with Functional Constipation. Nutrients. 25;14(23):5013. https://doi.org/10.3390/NU14235013
[21] Toshniwal SS, Kinkar J, Chadha Y, Khurana K, Reddy H, Kadam A, Acharya S (2024) Navigating the Enigma: A Comprehensive Review of Idiopathic Intracranial Hypertension. Cureus. 16;16(3):e56256. https://doi.org/10.7759/cureus.56256
Downloads
Published
How to Cite
License
Copyright (c) 2026 Cansu Kostakoğlu Duman, Muhammed Yıldırım, Talha Yamak, Döndü Melek Ulusoy, Ersin Kasım Ulusoy
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
