As with non-pregnant patients we check the systemic
blood pressure (this patient is normotensive)
and I ask about exogenous agents that can produce
IIH (eg, excessive vitamin A including the prenatal
supplements, steroids, tetracyclines, etc). I do tend to
monitor these patients more closely than my normal
IIH patients by seeing them in each trimester of their
pregnancy if they are stable and I perform the typical
IIH eye exam, fundus photography, and visual field
testing. I also coordinate their headache management
with their OB-GYN specialist (to select pregnancy
appropriate therapies) and their neurologist. Some
medications such as tricyclics can be considered after
the first trimester but other headache medicines that
are used in non-pregnant patients with IIH may be
contraindicated in pregnancy.