It is not uncommon for people with hydrocephalus to experience headaches. This information will discuss headaches and hydrocephalus in an attempt to give a better understanding of the possible issues faced.
Individuals with hydrocephalus, shunted or not, are frequently troubled by headaches. A diagnosis of the cause of headaches can be difficult and complicated and, as with the management of any chronic pain, it requires tremendous patience on the part of the person with hydrocephalus and the GP or Consultant.
Possible Causes of Headaches
Dr. Harold L. Rekate, Chief of Paediatric Neurosurgery at the Barrow Neurological Institute in Phoenix, Arizona, suggests five different reasons for headaches in a person with hydrocephalus:
1. Intermittent proximal shunt obstruction. This is often referred to as the classic 'slit ventricle syndrome.' Frequently the headaches last from 10-90 minutes and resolves on their own. Often occurring in the late afternoon, they can happen at any time. The headache can be severe, and may be associated with vomiting, photophobia (aversion to light), and it can resemble, to some extent, a migraine.
2. Small ventricles when the shunt fails and the ventricles can't grow to accommodate cerebrospinal fluid (CSF). This is more severe in people whose headaches come and stay; are present mostly in the morning, and can be associated with double vision. Their headaches are usually progressively more severe.
3. Intermittent failure of the shunt can produce a variety of headaches. The length of time that failure occurs is indeterminate and not predictable.
4. Extremely low shunt pressure can cause headaches that are similar to spinal headaches. In these cases, headache complaints are minimal when the patient is lying down but become more severe when the patient sits up or stands.
5. Migraine, a common affliction, can also occur in a person with hydrocephalus. Often there is a positive family history. Varying degrees of neurological dysfunction, headaches, vomiting, difficulty with vision and impairment of consciousness (including stupor) have been documented. Migraine attacks in shunted children and adolescents can create a disconcerting clinical situation for the patient, the family and the physician.
Dr. Gordon McComb, Head of Neurosurgery at Children's Hospital in Los Angeles, identifies similar reasons for headaches, but he narrowed them down to just three causes: migraine, shunt failure, and low pressure.