title: Clinical course and diagnosis of migraine headaches in hydrocephalic children.
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.
authors.affiliation: Department of Neurosciences, Children's Hospital of San Diego, Calif.
authors.forename: H E
authors.initials: HE
authors.lastname: James
authors.forename: T P
authors.initials: TP
authors.lastname: Nowak
mesh_terms: 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