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Introduction/Purpose Idiopathic intracranial hypertension (IIH) presents with elevated intracranial pressure (ICP) causing headaches and visual deterioration. While VSS and VPS effectively treat vision threatening disease, postoperative headache outcomes remain incompletely understood. We compared first-year postoperative headache-related healthcare utilization and medication use patterns between surgical groups.Materials and Methods This retrospective cohort study utilized Epic Cosmos, an electronic health record database, to compare headache-related outcomes between VSS and VPS in treatment-naïve adults with IIH from January 2023 to January 2026. The primary outcome was defined as any healthcare encounter with a chief complaint of headache or migraine within 31-365 days post-operatively. Secondary outcomes included changes in headache-related medication utilization (acetazolamide, analgesics, triptans, migraine preventives) between the first preoperative and first postoperative year. Unadjusted comparisons were performed using chi-squared analysis. Adjusted odds ratios were calculated using multivariable logistic regression controlling for age, BMI, baseline headache utilization (preoperative encounters), and baseline visual impairment (preoperative papilledema/visual disturbances/visual field defects/optic nerve sheath fenestration).Results Among 6,106 treatment-naïve adult patients with IIH who underwent index VSS (n = 2,852) or VPS (n = 3,254), 1,510 (24.7%) had headache-related healthcare utilization within 31-365 days post-operatively. On multivariable analysis, VSS was associated with lower odds of post-operative headache-related utilization than VPS (adjusted OR 0.86, 95% CI 0.74-0.99; p=0.04). Baseline headache utilization was the strongest predictor of postoperative utilization (adjusted OR 5.37, 95% CI 4.54-6.38; p<0.001). Acetazolamide and opioid use decreased after both procedures. VPS was associated with increased postoperative use of non-opioid analgesics and antiepileptic migraine preventives.Conclusions These findings may inform preoperative counseling and postoperative management when selecting ICP-lowering procedures. Prospective studies are warranted to validate these findings and identify modifiable predictors of postoperative headache outcomes.Disclosures B. Sankar: None. D. Johnson: None. A. Goyal: None.Abstract O-055 Figure 1