HeadWise HeadWise: Volume 3, Issue 2 | Page 19

Sonia Lal, MD Assistant Professor, Department of Neurology Loyola University of Chicago/ Stritch School of Medicine Maywood, Illinois José Biller, MD, FAAN, FACP, FAHA Professor and Chair, Department of Neurology Loyola University of Chicago/ Stritch School of Medicine Maywood, Illinois For individuals who complain of a headache due to exertion, there is often the question of a serious cause for their headache pain. It can be especially frightening to experience a severe headache because of coughing, exercise, or sexual activity. MRI, CT scans, and a thorough history are essential to rule-out a possible life-threatening basis for the pain. One of the causes that must be considered in exertional headache are the Chiari malformations. Chiari malformations are a group of developmental abnormalities that are located in the back of the brain. These malformations occur when the posterior or back region of the skull which contains the cerebellum is either too small or deformed, thus putting pressure on and crowding these nervous system structures. The lowermost portion of the cerebellum, known as the cerebellar tonsils, become displaced downwards into the upper spinal canal, and thus interferes with the normal flow of the cerebrospinal fluid (CSF) which circulates around the brain. These actions may lead to increased pressure inside the cranium and can also cause pressure on the upper spinal cord. Chiari malformations are classified into four different types depending on the part of the brain tissue that is displaced into the spinal canal and whether other developmental abnormalities are present. This article will focus on Chiari malformation type I – the most common type of these malformations. www.headaches.org | National Headache Foundation 17