Shunt Headaches vs. Migraines: How to Tell the Difference

Headaches are a common part of life with hydrocephalus and a VP shunt, but not all headaches mean the same thing. One of the most frustrating challenges shunted patients face is trying to tell the difference between a migraine, a pressure-related headache, or a potential shunt issue. This topic exists to help make sense of those differences and support safer decision-making.

Shunt-related headaches are often connected to changes in intracranial pressure. They may feel persistent, worsening, or different from a person’s usual headache pattern. Some people describe pressure, fullness, or a sensation that increases when lying down, bending over, or changing positions. These headaches may not respond well to typical migraine treatments and can be accompanied by nausea, vomiting, extreme fatigue, brain fog, or cognitive changes.

Migraines, on the other hand, often follow a familiar pattern for those who experience them. They may be triggered by stress, hormonal changes, certain foods, dehydration, or sensory overload. Migraines frequently include throbbing pain, light or sound sensitivity, visual disturbances, or aura. While migraines can be severe and debilitating, they usually respond to a known routine of rest, medication, or recovery time.

The overlap between shunt headaches and migraines is what makes this distinction difficult. Both can cause nausea, light sensitivity, dizziness, and fatigue. This overlap is also why shunted patients are sometimes told their symptoms are “just migraines,” even when something more serious may be happening.

One of the most important tools is knowing your baseline. If a headache feels new, stronger, longer-lasting, or different from your usual migraines—or if it comes with symptoms like confusion, extreme sleepiness, vision changes, or repeated vomiting—it deserves medical attention. A headache that doesn’t follow your normal migraine pattern is information, not inconvenience.

It’s also possible to have both migraines and shunt-related headaches. Having a history of migraines does not rule out shunt issues, and stable imaging does not always reflect how someone is feeling. Listening to your body and tracking patterns over time can help clarify what’s happening.

This topic isn’t meant to diagnose or replace medical advice. It’s meant to validate a reality many patients live with: navigating gray areas where symptoms don’t fit neatly into boxes. When in doubt, it is always safer to check in with your care team.

Trusting yourself is part of living with a shunt. Knowing the difference—or recognizing when you can’t tell—is enough reason to advocate for care.