They do not experience classic migraine, but may for some reason be vulnerable to similar variations of in blood volumn within the brain. Therefore, we now recommend that this regime be employed with all children experiencing chronic headache in the absence of obvious shunt malfunction. Intracranial pressure monitoring and surgery can also be considered when other avenues have been exhausted. Intracranial pressure monitoring is exceedingly useful in evaluating chronic headache complaints in shunt-dependent children and adults. Appropriate treatment is obviously dependent on identifying the true cause of the symptoms, and intracranial pressure should be determined in all such cases.
Intracranial hypertension can be more problematic to deal with.
First, it is confirmed that a CAT or MR scan has been obtained while the individual was maximally symptomatic to rule out an intermittent shunt malfunction. If this has been done, consideration is given to changing the shunt's valve if it is not a low resistance system. Finally, if headaches persist and pressure monitoring shows episodes of severe rise in intracranial pressure with resulting headache, either surgical expansion of the skull or establishing of bone widows under the temple's muscles can be done to allow underlying expansion of the brain to dissipate transient periods of increased pressure. In cases where pressure monitoring fails to document changes in intracranial pressure during periods of headache, the child or adult is referred to a headache clinic with the reassurance that there is no problem with the shunt's function.