Gr. Stellmanward et al., THE INCIDENCE OF CHRONIC HEADACHE IN CHILDREN WITH SHUNTED HYDROCEPHALUS, European journal of pediatric surgery, 7, 1997, pp. 12-14
Report of chronic headache amongst children with shunted hydrocephalus
is frequent, and often leads to investigation for raised intra-crania
l pressure and shunt malfunction, and much debate has appeared in the
literature concerning possible cause. However headache is a common neu
rological symptom amongst children, and studies of prevalence indicate
incidence of frequent non-migrainous headache to be 6.8%, and migrain
ous headache 4% in the general child population. A relationship betwee
n stress and anxiety and headache is recognised, and the hydrocephalic
child has many reasons above those of his/her peers to be subject to
stress. It is also hypothesised that this group may be more vulnerable
than peers to developing a migraine-like condition in the face of ade
quate shunt function. The clinician dealing with complaint of chronic
headache in a hydrocephalic child must therefore be wary of over-inves
tigation in a child with a working shunt, or missing possible shunt ma
lfunction when the only symptom is chronic headache. It was speculated
therefore that incidence of non-shunt related chronic headache in thi
s group would be high, and an attempt was made to document incidence o
f migrainous and non-migrainous headache in the medical notes, and in
replies to postal questionnaire sent to a sample of 130 children with
shunted hydrocephalus of varying aetiology. Incidence of migrainous he
adache was documented in the medical notes in 8.5% of cases, with inci
dence rising to 21.5% using self-report. Incidence of non-migrainous h
eadache was also very high (15.4%) and the overlap between migraine an
d tension headache, combined with difficulty of diagnosis in children
may indicate migraine to be more frequent still. The concept of ''Shun
t Migraine'' is therefore worthy of consideration. Report of chronic h
eadache led to investigation in a large proportion of cases, but sympt
omatology often continued. Even when shunt malfunction was indicated,
shunt revision did not ''cure'' complaint of headache. Headache was no
t found to be related to diagnosis associated with hydrocephalus, to p
resence of seizure disorder, or to the sex of the child, although in c
ommon with other studies, there was a strong trend towards girls being
statistically more likely to experience headache than boys. There was
a relationship however between report of chronic headache, and the so
rt of school a child was likely to attend; children who attended mains
tream school without the support of a Statement of Special Educational
Need were more likely to report headache than their peers, and it is
hypothesised that these children may be suffering sufficient stress to
contribute to maintenance of headache. The importance of the multi-di
sciplinary team in assessment of children's physical, intellectual and
emotional status is stressed, in order that medical interventions hav
e the greatest chance of success.