A Child with Migraine and Chiari Malformation Type 1

Abstract

A child with a long-standing, almost daily, headache has been assessed over several years. His clinical presentation was that of chronic tension-type headache with a psychiatric comorbidity of attention deficit hyperactivity disorder (ADHD). He also became dependent on excessive use of analgesic medications. In the course of his investigation, an MRI scan of the brain showed mild tonsillar descent through the foramen magnum (type 1 Chiari malformation), but with no associated symptoms to suggest spinal compression. In the assessment and management of this case, there will be full discussion of the primary headache disorder, the exacerbating factors, the comorbid illness, and the incidental finding of Chiari malformation.