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  • Title: Clinical course and diagnosis of migraine headaches in hydrocephalic children.
    Author: James HE, Nowak TP.
    Journal: Pediatr Neurosurg; ; 17(6):310-6; discussion 316. PubMed ID: 1840819.
    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.
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