Headache in children with Chiari I malformation.
BACKGROUND
Headache is the most common symptom of Chiari 1 malformation, a condition characterized by the herniation of cerebellar tonsils through the foramen magnum. However, the headache pattern of cases with Chiari 1 malformations is not well defined in the literature, especially in children.


OBJECTIVE
The aim of this retrospective chart review was to evaluate the frequency and the characteristics of headache in children with Chiari 1 malformation at initial evaluation and during follow up.


METHODS
Forty-five cases with tonsillar ectopia were selected among 9947 cases under 18 years of age who underwent neuroimaging between 2002 and 2010. A semistructured clinical interview (mean follow-up: 5.2 years) was conducted. Headache was classified according to the second edition of the International Classification of Headache Disorders.


RESULTS
Possible associations between clinical picture, in particular headache pattern, but also other signs and symptoms attributable to Chiari 1 malformation, and the extent of tonsillar ectopia were found for 3 different groups: those with borderline (<5 mm, N = 12), mild (5-9 mm, N = 27), and severe tonsillar ectopia (≥10 mm, N = 6), respectively. Twenty-four out of 33 (73%) cases with Chiari 1 malformation complained of headache, and 9/33 (27%) of those patients (5 with mild and 4 with severe tonsillar ectopia) reported headache attributed to Chiari 1 malformation.


CONCLUSIONS
In our studied pediatric population, the most common symptom for cases diagnosed with Chiari 1 malformation was headache, and headache attributed to Chiari 1 malformation was the most common headache pattern in patients with Chiari 1 malformation. The presence of headache attributed to Chiari 1 malformation along with 3 other signs or symptoms of Chiari 1 malformation were highly predictive of severe tonsillar ectopia.
Juvenile Headache Centre, Department of Woman and Child Health, University of Padua, Padua, Italy.
Irene
I
Toldo
Marta
M
Tangari
Rodica
R
Mardari
Egle
E
Perissinotto
Stefano
S
Sartori
Michela
M
Gatta
Milena
M
Calderone
Pier Antonio
PA
Battistella
D000293:Adolescent; D001139:Arnold-Chiari Malformation / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006261:Headache / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D059906:Neuroimaging; D012189:Retrospective Studies
Chiari 1 malformation; ICHD-II; cerebellar tonsils herniation; children; headache