Headache Experience of the Child and the Adolescent with Shunted Hydrocephalus

Hydrocephalus is a common pediatric neurosurgical condition affecting the body’s ability to regulate cerebral spinal fluid. Treatment commonly involves insertion of a ventriculoperitoneal (VP) shunt re-establishing cerebral spinal fluid flow. Shunts are prone to malfunction, with headache being a common symptom. Headache has predominantly been recognized as a sign of shunt malfunction and not seen as a pain event. While headache is common in pediatric hydrocephalus patients with an apparently functional shunt, it has not been rigorously investigated putting them at risk for the consequences of unresolved pain. Researchers have not addressed headache within this patient population outside of shunt functioning or the impact of headache from the child and adolescent perspective. Drawing on the Gate Control Theory, the Neuromatrix Theory of Pain and the International Headache Societies Headache Classification system, a mixed methods study design was undertaken to (a) determine the prevalence, frequency and nature of headaches, (b) describe potential child factors associated with headaches and (c) evaluate the impact of headaches on the child’s and adolescent’s’ school, social and family life. Sixty six percent of children and adolescents reported headache within a one month period. Based on the modified International Headache Society’s criteria, 13.0% of headaches were tension-like, 13.2% were unclassifiable 33.5% were migraine-like and 38.8% were mixed. Etiology was significant with children diagnosed with tumour and congenital without myelomeningocele having a decreased tendency to report headache compared to children diagnosed with congenital with myelomeningocele. Children and adolescents described hidden emotions and missing out on many of their school, social and family activities. The main themes from the qualitative analysis were invisibility, normalcy and control/out of control. Etiology and multiple psychosocial and psychological factors potentially influence the headache experience in children and adolescents with shunted hydrocephalus. Future studies are required to further explore and delineate factors impacting headache within this study population.Ph