When should I consider referring a patient with idiopathic intracranial hypertension to a specialist?

Consider referring a patient with idiopathic intracranial hypertension (IIH) to a specialist if:

• There is diagnostic uncertainty or atypical symptoms that make the diagnosis unclear.
• Symptoms persist despite optimal management in primary care.
• There are red flags or signs suggestive of a serious underlying cause of headache.
• Visual symptoms or signs of visual impairment develop, as IIH can threaten vision and requires specialist assessment.

Referral urgency depends on clinical judgement, especially if there is concern about vision or neurological deficits.

These recommendations align with NICE and other UK headache management guidelines that advise specialist referral when diagnosis is uncertain, symptoms persist despite treatment, or serious causes need exclusion ¹,³.