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Migraine headaches in hydrocephalic children: a diagnostic dilemma
1Department of Neurosurgery, Hahnemann University, School of Medicine, Philadelphia, Pennsylvania.
Insights
Children with hydrocephalus and shunts experiencing recurring symptoms like headaches and vomiting may have migraines, not shunt issues. Consider migraine treatment before further surgery if shunts function properly.
Area of Science:
- Pediatric Neurology
- Neurosurgery
Background:
- Hydrocephalus management often involves cerebrospinal fluid (CSF) shunts.
- Shunt malfunction can present with symptoms like headaches, vomiting, and altered sensorium.
Observation:
- Five children with hydrocephalus and CSF shunts presented with recurrent headaches, vomiting, and impaired consciousness.
- Initial diagnoses included shunt malfunction, slit ventricle syndrome, and overshunting, leading to multiple interventions.
- Symptoms persisted despite various procedures.
Findings:
- Migraine diagnosis was considered when shunt function was adequate.
- Four patients improved with propranolol, and one responded to verapamil.
- This suggests a potential role for migraine treatment in this patient group.
Implications:
- In children with hydrocephalus and shunts, migraine should be considered in the differential diagnosis for recurrent neurological symptoms.
- Evaluating for migraine may prevent unnecessary surgical interventions.
- This approach can improve patient outcomes and reduce healthcare costs.
Abstract:
Headaches, vomiting, and altered sensorium can be seen in patients with shunt malfunction as well as in those with migraines. We report five cases in which children with hydrocephalus and CSF shunts presented with a variety of recurring symptoms, including headache, vomiting, impairment of consciousness to the point of coma, and, in one patient, decerebrate posturing. Various diagnoses were entertained: shunt malfunction, slit ventricle syndrome, and low pressure (overshunting). Repeated procedures were carried out in all patients, including shunt taps, multiple shunt revisions, and a subtemporal decompression. When the diagnosis of migraine was considered, four patients improved on propranolol therapy; one failed this therapy but responded to verapamil. We conclude that in patients with hydrocephalus and repeated bouts of symptoms such as headaches, vomiting, and impairment of consciousness and in the case of documented, adequate shunt function, the diagnosis of migraine be entertained before further operative intervention is undertaken.