The use of abdominal binders to treat over-shunting headaches: Clinical article

Department of Pediatric Neurosurgery, Children’s Medical Center Dallas, TX 75235, USA.
Journal of Neurosurgery Pediatrics (Impact Factor: 1.48). 06/2012; 9(6):615-20. DOI: 10.3171/2012.2.PEDS11146
Source: PubMed


Headaches are common in children with shunts. Headaches associated with over-shunting are typically intermittent and tend to occur later in the day. Lying down frequently makes the headaches better. This paper examines the efficacy of using abdominal binders to treat over-shunting headaches.
Over an 18-year period, the senior author monitored 1027 children with shunts. Office charts of 483 active patients were retrospectively reviewed to identify those children with headaches and, in particular, those children who were thought to have headaches as a result of over-shunting. Abdominal binders were frequently used to treat children with presumed over-shunting headaches, and these data were analyzed.
Of the 483 patients undergoing chart review, 258 (53.4%) had headache. A clinical diagnosis of over-shunting was made in 103 patients (21.3% overall; 39.9% of patients with headache). In 14 patients, the headaches were very mild (1-2 on a 5-point scale) and infrequent (1 or 2 per month), and treatment with an abdominal binder was not thought indicated. Eighty-nine patients were treated with a binder, but 19 were excluded from this retrospective study for noncompliance, interruption of the binder trial, or lack of follow-up. The remaining 70 pediatric patients, who were diagnosed with over-shunting headaches and were treated with abdominal binders, were the subjects of a more detailed retrospective study. Significant headache improvement was observed in 85.8% of patients. On average, the patients wore the binders for approximately 1 month, and headache relief usually persisted even after the binders were discontinued. However, the headaches eventually did recur in many of the patients more than a year later. In these patients, reuse of the abdominal binder was successful in relieving headaches in 78.9%.
The abdominal binder is an effective, noninvasive therapy to control over-shunting headaches in most children. This treatment should be tried before any surgery is considered. It is suggested that the abdominal binder may modulate abnormally increased intracranial pulse pressures associated with over-shunting. Interactions with the cerebrovascular bed are suspected to account for persistent headache relief after the binder is discontinued.

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    ABSTRACT: Background and aim: The use of abdominal binders after laparotomy is a question of habit. Scientific evidence of their usefulness is limited. The aims of this work were to review the scientific literature and to depict the practices of French surgeons regarding the use of these devices. Methods: A systematic review of the literature about the use of abdominal binders after laparotomy was conducted. In order to depict surgeons' habits, an anonymous questionnaire was sent to all surgical departments affiliated to the FRENCH network (Federation of Surgical Research) and their surgical contacts. They were all asked about their use of binders, the type of binders they ordered, the expected benefit, the cost and the need for a randomized trial in this field. Results: Only four trials have been published regarding the use of abdominal binders after laparotomy, all with a small number of patients. Some authors suggested that wearing binders procured a benefit in terms of postoperative comfort, but no significant difference was found. One study also suggested an improvement in respiratory volumes. No study focused on incisional hernia. Regarding the survey of practices, 50 questionnaires were retained for the final analysis (one questionnaire per department of surgery). The use of this device is really very frequent in France (94 % of surgeons order them), a habit usually acquired during the training in surgery. The main expected benefit is the prevention of abdominal wall dehiscence (83 %), but also an improvement in patients' postoperative comfort and pain (66 %). Although some surgeons order an abdominal binder for all their patients, most use them in selected patients (according to the operation and the patients' characteristics). Conclusion: Abdominal binders are frequently ordered by French surgeons after laparotomy. The expected benefit is the prevention of abdominal-wall complications, even though no data actually support this practice. Binders might have a benefit in terms of postoperative pain relief, but this needs to be analyzed. A prospective randomized trial is warranted.
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