Clinical course and diagnosis of migraine headaches in hydrocephalic children.
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.
James
H E
HE
Department of Neurosciences, Children's Hospital of San Diego, Calif.
Nowak
T P
TP
D002557:Cerebrospinal Fluid Shunts / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008881:Migraine Disorders / Q000209:etiology* / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D017287:Ventriculoperitoneal Shunt / Q000295:instrumentation