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Clinical course and diagnosis of migraine headaches in hydrocephalic children
Insights
Migraines can mimic shunt malfunctions in hydrocephalus patients presenting with neurological symptoms. Consider migraine diagnosis in patients with small ventricles and a family history before additional surgery.
Area of Science:
- Neurology
- Neurosurgery
Background:
- Headaches, vomiting, and altered sensorium are common symptoms in both migraines and shunt malfunctions.
- Hydrocephalus and cerebrospinal fluid (CSF) shunts are treatments for various neurological conditions.
Purpose of the Study:
- To investigate the potential misdiagnosis of migraines as shunt malfunctions in patients with hydrocephalus and CSF shunts.
- To identify clinical indicators that may suggest migraine over shunt issues.
Main Methods:
- Case report of 10 patients with hydrocephalus and CSF shunts presenting with neurological symptoms.
- Evaluation of diagnostic considerations including shunt malfunction, slit ventricle syndrome, and low-pressure hydrocephalus.
- Therapeutic trials with propranolol and verapamil, alongside surgical interventions.
Main Results:
- 70% of patients had a family history of migraines.
- 80% of patients showed improvement with propranolol therapy.
- Two patients required further shunt procedures after initial medical management.
Conclusions:
- In hydrocephalus patients with small ventricles on imaging, a family history of migraines, and adequate shunt function, migraine should be considered.
- Migraine diagnosis may prevent unnecessary surgical interventions in select patient populations.
Abstract:
Headaches, vomiting and altered sensorium can be seen in patients with migraines as well as in patients with shunt malfunctions. This is a report of 10 patients with hydrocephalus and CSF shunts who presented with headache, vomiting, varying degrees of impairment of consciousness, and coma. Various diagnostic considerations were made: shunt malfunction, slit ventricle syndrome and low pressure (overshunting). Repeated operative procedures were performed in all. 7 of 10 patients had a family history of migraines when the diagnosis of migraine was entertained, 8 patients improved on propranolol therapy, 1 failed with this therapy but responded to verapamil. In the remaining 2 patients, after a transient response to propranolol, compartmentalized hydrocephalus became obvious and improvement followed with shunt procedures. It is concluded that in those patients with hydrocephalus and small ventricles on neuroimaging and a family history of migraines, and in the face of documented adequate shunt function, the diagnosis of migraines be entertained before further operative interventions.