Patients with a Chiari Type I malformation (herniation of cerebellar tonsils through the foramen magnum) may present with headache.

Pathogenesis: structural lesion in the posterior fossa


Features of the headache:

(1) headache may be precipitated by cough, exercise, laughing and/or sex

(2) variable headache with the Valsalva maneuver

(3) occipital and neck pain


Additional clinical features may include:

(1) dizziness

(2) pain or paresthesias in the arm

(3) restriction in neck movement

(4) ataxia


Imaging of the posterior fossa is important for diagnosis


Differential diagnosis:

(1) subarachnoid hemorrhage

(2) other forms of headache (primary cough, etc)

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