Headache in Chiari Malformation

Bezuidenhout, Abraham F.; Chang, Yu‐Ming; Heilman, Carl B.; Bhadelia, Rafeeque A.

doi:10.1016/j.nic.2019.01.005

Cited by 20 publications

(30 citation statements)

References 22 publications

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“…It would therefore be attractive to think that at least in some of our cases, Valsalva-induced headaches could have occurred on the basis of mechanisms shared with CM1 Valsalva-induced headaches. As recently reviewed by Bezuidenhout and colleagues (14), a transient pressure dissociation between the head and spine may be an important underlying mechanism in CM1 Valsalva-induced headaches. During Valsalva, an initial spinal pressure elevation (from intra-thoracic pressure elevation and resultant epidural venous distension) displaces CSF to the head.…”

Section: Discussionmentioning

confidence: 87%

Headache due to spontaneous spinal cerebrospinal fluid leak secondary to cerebrospinal fluid-venous fistula: Case series

et al. 2019

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Objective Cerebrospinal fluid-venous fistula is an uncommon cause of spontaneous spinal cerebrospinal fluid leak (SSCSFL). We aim to describe the clinical presentation, imaging evaluation, treatment and outcome of SSCSFL secondary to cerebrospinal fluid-venous fistula. Methods A retrospective review was undertaken of SSCSFL cases secondary to cerebrospinal fluid-venous fistula confirmed radiologically or intraoperatively, seen at our institution from January 1994 to March 2019. Cases with undetermined SSCSFL etiology, alternative etiology or unconfirmed fistula were excluded. Results Forty-four of 156 patients met the inclusion criteria (31 women, 13 men). Mean age of symptom onset was 52.6 years (SD 8.7, range 33–71 years). Headache was the presenting symptom in almost all, typically daily (69%), and most often in occipital/suboccipital regions. Headache character was most commonly pressure (38%), followed by throbbing/pulsing (21.4%). Orthostatic headache worsening occurred in 69% and an even greater percentage of patients (88%) reported Valsalva-induced headache exacerbation or precipitation. Headache occurred in isolation to Valsalva maneuvers in 12%. Of 37 patients with documented cerebrospinal fluid opening pressure, 13% were <6 cmH2O; 84%, 7–20 cmH2O; and one, 25 cmH2O. Fistulas were almost exclusively thoracic (95.5%). Only one patient responded definitively to epidural blood patch (EBP). Forty-two patients underwent surgery. Most improved following surgery; 48.7% were completely headache free and 26.8% had at least 50% improvement. Conclusion In our series, cerebrospinal fluid-venous fistula was associated with a greater occurrence of Valsalva-induced headache exacerbation or precipitation than orthostatic headache and did not respond to EBP. Surgery provided significant improvement. Cerebrospinal fluid-venous fistula should be considered early in the differential diagnosis of Valsalva-induced (“cough”) headache.

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Section: Discussionmentioning

confidence: 87%

Headache due to spontaneous spinal cerebrospinal fluid leak secondary to cerebrospinal fluid-venous fistula: Case series

et al. 2019

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“…Presence of CAH in a CMI patient is generally an indication for decompressive surgery and a predictor of a better outcome. 19 Therefore, CAH is the potential indicator of clinically significant disease in a CMI patient who needs to be further evaluated. 14…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown that tonsillar measurements made in the midsagittal plane do not fully estimate the neural crowing and are inadequate indicators of the presence of CAH in a CMI patient. 5,13,[19][20][21] Prior studies comparing the midsagittal ETH between those with and without CAH showed conflicting results. While Alperine et al 20 and Sansur et al 21 failed to find any differences, Huang et al 14 showed significant differences in the midsagittal ETH between the two groups.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic utility of parasagittal measurements of tonsillar herniation in Chiari I malformation

et al. 2021

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Background and purpose Although the cerebellar tonsils are parasagittal structures, the extent of tonsillar herniation (ETH) in Chiari I malformation (CMI) is currently measured in the midsagittal plane. We measured the ETH of each cerebellar tonsil in the parasagittal plane and assessed their diagnostic utility by comparing them to the midsagittal ETH measurements in predicting cough-associated headache (CAH), an indicator of clinically significant disease in CMI. Methods Eighty-five CMI patients with 3D-MPRAGE images were included. Neurosurgeons determined the presence of CAH. Sagittal images were used to measure ETH in the midsagittal (MS_ETH) and parasagittal planes (by locating tonsillar tips on each side on reformatted coronal images). Given the parasagittal ETH (PS_ETH) asymmetry in the majority of cases, they were considered Smaller_PS_ETH or Larger_PS_ETH. The accuracy of ETH measurements was assessed by the receiver operating characteristic (ROC) curve. Results Of 85 patients, 46 reported CAH. ROC analysis showed an area under the curve (AUC) of 0.78 for Smaller_PS_ETH significantly better than 0.65 for MS-ETH in predicting CAH ( p = 0.001). An AUC of 0.68 for Larger_PS_ETH was not significantly different from MS_ETH. The sensitivity and specificity of predicting CAH were 87% and 28% for MS_ETH >6 mm versus 90% and 46% for Smaller_PS_ETH >6 mm, and 52% and 67% for MS_ETH >9 mm versus 48% and 87% for Smaller_PS_ETH >9 mm. At ETH >15 mm, no differences were seen between the measurements. Conclusions Diagnostic utility of ETH measurements in detecting clinically significant CMI can be improved by parasagittal measurements of the cerebellar tonsillar herniation.

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“…Their unwillingness to do excessive examination in the context of respiratory clinics aroused our reflection on the necessity for and indications of an MRI scan. Some recent findings merit attention: Firstly, even if CM-I was detected, routine MRI was inadequate to assure the association between CH and CM-I (10,34,35). Secondly, 37–40% of cough headache found in CM-I patients improved at follow-up and most asymptomatic individuals with CM-I remained asymptomatic (93.3%) according to a systematic review (36).…”

Section: Discussionmentioning

confidence: 99%

Prevalence and characteristics of cough headache in a Chinese respiratory clinic

et al. 2020

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Background To evaluate the prevalence, predictive factors and clinical characteristics of cough headache in our respiratory clinic and to investigate the coexistence between cough headache, migraine and tension-type headache. Method We consecutively investigated patients referred to our respiratory clinic with complaints of cough and selected patients with cough headaches to complete a structured interview and examination. Results Six hundred and seventy-nine patients with cough were studied and 122 patients were diagnosed with cough headache. The prevalence of cough headache was 18.0% in these coughing patients. According to multivariate analysis, being of an age between 31–50 years was a risk factor for cough headache (OR 2.0). Cough headache was associated with cough severity: Compared with the mild group, the moderate group (OR 2.3) and the severe group (OR 3.3) were more vulnerable to cough headache. Headache severity had a positive correlation with cough severity (ρ = 0.301, p = 0.028), age (ρ = 0.199, p = 0.029), and headache duration (ρ = 0.242, p = 0.008). In cough headache patients, 30.3% had tension-type headache and 10.7% had migraine in the preceding year. Conclusions Cough headache is not rare in respiratory clinics and the characteristics are somewhat different from those in headache clinics. An age of between 31–50 years and cough severity were risk factors for cough headache. Headache severity was related to cough severity, age and headache duration.

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Headache in Chiari Malformation

Cited by 20 publications

References 22 publications

Headache due to spontaneous spinal cerebrospinal fluid leak secondary to cerebrospinal fluid-venous fistula: Case series

Headache due to spontaneous spinal cerebrospinal fluid leak secondary to cerebrospinal fluid-venous fistula: Case series

Diagnostic utility of parasagittal measurements of tonsillar herniation in Chiari I malformation

Prevalence and characteristics of cough headache in a Chinese respiratory clinic

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