HEADACHES IN CHIARI MALFORMATION

Introduction. Chiari malformation type 1 is found incidentally in 0.7-1% of children and adolescents undergoing magnetic resonance imaging of the brain and spine, and in 0.5% of cases in the adult population. The most common posterior fossa condition associated with cough headaches is Chiari malformation type 1. This condition results from a mesodermal defect, leading to a disparity between the sizes of the posterior cranial fossa and the neural structures it contains. According to the latest international classification of headaches, established by the Committee of the International Headache Society, cough headaches are categorized into primary and secondary (symptomatic) types. Primary cough headaches typically have a benign course. In contrast, symptomatic cough headaches are associated with pathological changes in the bone structure of the posterior cranial fossa and its contents, particularly seen in Chiari malformation type 1. Aim: To identify the characteristics of headaches in Chiari malformation. Materials and Methods. Literature analysis was conducted using international databases, such as Web of Science, Scopus, and PubMed, as well as the domestic library system eLibrary. Results and Discussion. Headaches, along with hydrosyringomyelia, are considered an indication for neurosurgical intervention. However, if we look at headaches as the sole reason for surgery, we must consider their origin. In cases of Chiari malformation, headaches may be linked to migraine or other primary headache types due to their common occurrence. Cough and stress headaches are specific indicators of Chiari malformation. In some instances, Chiari malformation type 1 characterized by dislocation of the cerebellar tonsils, may be a secondary phenomenon resulting from fluctuations in intracranial pressure. This condition can also cause headaches that stem from the secondary dislocation of the cerebellar tonsils. Consequently, the question of whether the dislocation of the cerebellar tonsils, accompanied by headaches, is primary or secondary is particularly relevant. Conclusions. Chiari malformation type 1 is associated with headaches of various types, which can sometimes be challenging for distinguishing them from primary headaches. This necessitates mandatory neuroimaging and careful differential diagnosis by neurologists.