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Causes of Headaches in children: Hydrocephalus
Hydrocephalus is another condition which is largely a disease of the very young. Cerebro-spinal fluid (CSF) is created in chambers called the ventricles, deep within the brain, and flows out to the outside of the brain through a small set of channels. Here it bathes the brain, and then passes down the spinal canal, where it is re­absorbed. If there is an obstruction to the exit of CSF from within the brain, the pressure inside the head rises and as a result progressively blows the brain up from the inside, like a balloon. This is hydrocephalus, sometimes known as 'water on the brain'. Obstructions to the outflow of CSF include: a congenital narrowing of the drainage canal; a tumour which is pressing on the outflow tract; or, after meningitis, which has scarred the outflow tract so that it becomes blocked and can no longer drain the fluid properly.
The effects of hydrocephalus vary according to the age of the child. In the very young child the skull bones are separate, fusing together as the child gets older. In a very young child who hasn't yet fused her skull bones, this extra pressure distends the brain and also makes the skull swell. Because the skull can swell, the pressure on the brain doesn't rise that much, so this doesn't give as much pain as you might imagine. However, in the older child where the skull bones have fused, a rise of pressure within the ventricles squashes the brain against the unyielding inside of the skull, causing severe headaches, vomiting and other symptoms.
The treatment is to release the pressure, usually by putting in an artificial drainage lube called a shunt, to drain the excess CSF away. Often these shunts work for a number of years, and then become gummed up, but by then the skull and brain may have grown sufficiently for the normal drainage channels to reopen.
Hydrocephalus can also occur in adults, principally because of tumours which block the drainage of CSF. The reason hydrocephalus is more common in children is that it is associated with certain types of malformation that exist at birth, especially those' related to certain types of spina bifida (a disorder of the spine and spinal cord). The increased incidence of brain tumours in childhood also means that there is more chance of a tumour obstructing the drainage channel. Meningitis, which can 'gum up' the drainage channel, is also more common in earlier life.
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