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Headache in Children With C hiari I Malformation
Author(s) -
Toldo Irene,
Tangari Marta,
Mardari Rodica,
Perissinotto Egle,
Sartori Stefano,
Gatta Michela,
Calderone Milena,
Battistella Pier Antonio
Publication year - 2014
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.12341
Subject(s) - medicine , foramen magnum , chiari malformation , pediatrics , population , surgery , magnetic resonance imaging , radiology , syringomyelia , environmental health
Background Headache is the most common symptom of C hiari 1 malformation, a condition characterized by the herniation of cerebellar tonsils through the foramen magnum. However, the headache pattern of cases with C hiari 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 C hiari 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 I nternational C lassification of H eadache D isorders. Results Possible associations between clinical picture, in particular headache pattern, but also other signs and symptoms attributable to C hiari 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 C hiari 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 C hiari 1 malformation. Conclusions In our studied pediatric population, the most common symptom for cases diagnosed with C hiari 1 malformation was headache, and headache attributed to C hiari 1 malformation was the most common headache pattern in patients with C hiari 1 malformation. The presence of headache attributed to C hiari 1 malformation along with 3 other signs or symptoms of C hiari 1 malformation were highly predictive of severe tonsillar ectopia.