Chiari malformation describes a structural problem where brain tissue extends into the spinal canal. This occurs when the skull is misshapen or smaller than typical, causing pressure on the brain and forcing a part of it, specifically the cerebellum, downwards into the opening at the base of the skull, known as the foramen magnum. While some individuals with this condition may not experience symptoms, many develop a characteristic type of headache.
Understanding the Pain of a Chiari Headache
A Chiari headache presents as pain at the back of the head, often described as suboccipital, and can extend to the neck and shoulders. The pain quality varies, ranging from a throbbing or pressure-like sensation to sharp, stabbing, or aching. Its intensity can fluctuate from mild to severe, and it may be constant or intermittent. For some, the pain can reach an average maximum intensity of 7.8 out of 10 on a pain scale.
Common Triggers and Aggravating Factors
Chiari headaches are influenced by specific activities that increase intracranial pressure. Actions such as coughing, sneezing, straining (like during a bowel movement), laughing, crying, or bending over frequently induce or worsen the headache. These activities, often referred to as Valsalva maneuvers, can cause a sudden, sharp increase in pain.
The pressure on the brainstem and spinal cord, along with obstructed cerebrospinal fluid (CSF) flow, contributes to this aggravation. Avoiding strenuous activities, heavy lifting, and even contact sports is often recommended to minimize these triggers and prevent symptoms from worsening.
Accompanying Symptoms of Chiari Headaches
Beyond the headache itself, Chiari malformation can manifest with a range of other symptoms that frequently occur concurrently. Neck pain and stiffness are common companions to the headache. Individuals may also experience dizziness or vertigo, along with balance problems and an unsteady walk.
Visual disturbances like blurred vision, double vision, or sensitivity to light can also be present. Other associated neurological symptoms include difficulty swallowing, speech changes such as hoarseness, numbness or tingling in the extremities, and ringing in the ears (tinnitus).
Differentiating Chiari Headaches from Other Headaches
Chiari headaches possess distinct characteristics that help differentiate them from more common headache types, such as migraines or tension headaches. Unlike other headache types, Chiari headaches are uniquely characterized by their occipital or suboccipital location. A key distinguishing feature is their exacerbation by activities that increase intracranial pressure, a trigger not commonly seen in other headaches.
Additionally, the presence of accompanying neurological symptoms, such as balance issues, visual disturbances, or swallowing difficulties, further helps differentiate them. While some Chiari headaches may present with migraine-like or tension-type features, their specific location and triggers are often key indicators. Standard over-the-counter headache medications often provide limited relief for Chiari headaches. Surgical decompression, aiming to relieve pressure on the brain, often leads to improvement in these specific headaches.