Counsel pregnant patients with IIH using outcome data rather than fear, but escalate promptly when visual metrics worsen or orthostatic features suggest an alternative CSF-pressure disorder.

Established IIH does not necessarily worsen visual prognosis during pregnancy; New IIH presenting during pregnancy may show more severe papilledema and visual burden; Pregnancy counseling remains a major unmet need in women with IIH; Orthostatic headache should prompt consideration of both dysautonomia and CSF pressure disorders; Chiari malformation and syringomyelia can contribute to posterior headache syndromes