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When we sat down to discuss this paper by Sioutas et al,1 we were struck immediately by how much uncertainty still surrounds idiopathic intracranial hypertension (IIH). Elevated body mass index (BMI) probably remains the most important risk factor and therefore target for disease modification,2 yet the treatments that are currently available are far from perfect. In the absence of impending sight loss, consensus guidelines recommend weight loss and medical therapy with carbonic anhydrase inhibitors.3 Surgical intervention, including cerebrospinal fluid (CSF) shunting, optic nerve sheath fenestration and venous sinus stenting, is only indicated if there is an imminent risk to vision. However, maintained weight loss is often difficult to achieve, and although bariatric surgery provides a potential alternative in some patients, it is not always readily available.4 There is also a lack of efficacious and tolerable medications to lower intracranial pressure (ICP) while attempting weight loss. Acetazolamide, the mainstay treatment, is frequently stopped due to side effects.5 Topiramate offers only modest benefit6 and also carries a substantial side effect burden. We found ourselves asking: what else is out there, and could new therapies change the trajectory for these patients?