Headaches in patients with shunts.

Headache is one of the most common afflictions suffered by humans. Headache in patients with a shunt triggers a series of events that includes utilization of expensive technologies and often potentially dangerous surgical intervention. The purpose of this study was to determine the incidence of headaches in patients with shunts and, hopefully, the relationship of those headache disorders to the treatment of hydrocephalus. The Hydrocephalus Association maintains a self-reporting database recorded from individuals treated for hydrocephalus and their families. This database was mined to determine the incidence of severe headaches requiring treatment and interfering with normal life in patients who have been treated for hydrocephalus. There were 1,242 responders between the ages of 19 months and 45 years of age. Of these, 1,233 answered the question, "Do you or your family member suffer from (does your child complain of) frequent or chronic headaches?" This subset forms the basis of this study. Three groups were defined by age: children (19 months-12 years), adolescents (13 years-19 years), and young adults (20 years-45 years). Most respondents were initially treated during infancy (before 18 months of age); 84% of children and 69% of both adolescents and young adults were treated very early in life. Severe headaches became a more frequent problem as the age of the population treated for hydrocephalus increased. In terms of frequency and severity of headaches, direct comparisons with epidemiologic studies of normal populations are difficult because of the limitations of data available in the database. However, it is likely that this population has a higher incidence of severe headaches than normal populations. The cost of management of headaches in this population is very high, and the patients are at risk throughout life. Early treatment decisions have a significant effect on later quality of life. Strategies that lead to normalization of cerebrospinal fluid dynamics and life without shunt dependency are justified if they can be shown to improve later quality of life.