BACKGROUND: Headache is the main and often isolated symptom of patients with Chiari type 1 malformation (CM1). Classically described as occipital and exacerbated by cough, headaches may be poorly characterized, making it difficult to establish CM1 as the underlying cause. Current guidelines for surgical posterior fossa decompression are undefined. The challenge is to distinguish headaches related to CM1 from headaches coincidentally coexisting with CM1. We aimed to determine predictive factors of headache resolution after surgery and applied to our cohort the Chiari Severity Index, a recently developed predictive prognostic score. METHODS: This retrospective study enrolled 49 patients with CM1 and preoperative headache. Standardized telephone interviews regarding headaches before and after surgery were conducted by the same neurologist; magnetic resonance imaging morphometric analyses were performed by an independent neuroradiologist. Headache resolution was defined as ≥50% reduction in frequency of headache days. RESULTS: Preoperative factors of headache resolution after multivariate analysis were attack duration <5 minutes (P = 0.001), triggering by Valsalva maneuvers (P = 0.003), severe intensity of attack (P = 0.05), occipital location (P = 0.05), and greater number of headache days per month (P = 0.04). These characteristics are part of International Headache Society diagnostic criteria for headache attributed to CM1. No radiologic predictive factor was demonstrated. Postoperative improvement was inversely correlated with Chiari Severity Index. CONCLUSIONS: This study confirms the relevance of International Headache Society criteria to identify headaches related to CM1. We propose their systematic use in a preoperative questionnaire.
BACKGROUND:Headache is the main and often isolated symptom of patients with Chiari type 1 malformation (CM1). Classically described as occipital and exacerbated by cough, headaches may be poorly characterized, making it difficult to establish CM1 as the underlying cause. Current guidelines for surgical posterior fossa decompression are undefined. The challenge is to distinguish headaches related to CM1 from headaches coincidentally coexisting with CM1. We aimed to determine predictive factors of headache resolution after surgery and applied to our cohort the Chiari Severity Index, a recently developed predictive prognostic score. METHODS: This retrospective study enrolled 49 patients with CM1 and preoperative headache. Standardized telephone interviews regarding headaches before and after surgery were conducted by the same neurologist; magnetic resonance imaging morphometric analyses were performed by an independent neuroradiologist. Headache resolution was defined as ≥50% reduction in frequency of headache days. RESULTS: Preoperative factors of headache resolution after multivariate analysis were attack duration <5 minutes (P = 0.001), triggering by Valsalva maneuvers (P = 0.003), severe intensity of attack (P = 0.05), occipital location (P = 0.05), and greater number of headache days per month (P = 0.04). These characteristics are part of International Headache Society diagnostic criteria for headache attributed to CM1. No radiologic predictive factor was demonstrated. Postoperative improvement was inversely correlated with Chiari Severity Index. CONCLUSIONS: This study confirms the relevance of International Headache Society criteria to identify headaches related to CM1. We propose their systematic use in a preoperative questionnaire.
Authors: William H Shuman; Aislyn DiRisio; Alejandro Carrasquilla; Colin D Lamb; Addison Quinones; Aymeric Pionteck; Yang Yang; Mehmet Kurt; Raj K Shrivastava Journal: Neurosurg Rev Date: 2021-07-13 Impact factor: 3.042
Authors: Travis S CreveCoeur; Alexander T Yahanda; Cormac O Maher; Gabrielle W Johnson; Laurie L Ackerman; P David Adelson; Raheel Ahmed; Gregory W Albert; Phillipp R Aldana; Tord D Alden; Richard C E Anderson; Lissa Baird; David F Bauer; Karin S Bierbrauer; Douglas L Brockmeyer; Joshua J Chern; Daniel E Couture; David J Daniels; Robert C Dauser; Susan R Durham; Richard G Ellenbogen; Ramin Eskandari; Herbert E Fuchs; Timothy M George; Gerald A Grant; Patrick C Graupman; Stephanie Greene; Jeffrey P Greenfield; Naina L Gross; Daniel J Guillaume; Gabe Haller; Todd C Hankinson; Gregory G Heuer; Mark Iantosca; Bermans J Iskandar; Eric M Jackson; Andrew H Jea; James M Johnston; Robert F Keating; Michael P Kelly; Nickalus Khan; Mark D Krieger; Jeffrey R Leonard; Francesco T Mangano; Timothy B Mapstone; J Gordon McComb; Arnold H Menezes; Michael Muhlbauer; W Jerry Oakes; Greg Olavarria; Brent R O'Neill; Tae Sung Park; John Ragheb; Nathan R Selden; Manish N Shah; Chevis Shannon; Joshua S Shimony; Jodi Smith; Matthew D Smyth; Scellig S D Stone; Jennifer M Strahle; Mandeep S Tamber; James C Torner; Gerald F Tuite; Scott D Wait; John C Wellons; William E Whitehead; David D Limbrick Journal: Neurosurgery Date: 2021-01-13 Impact factor: 4.654
Authors: Dennis C Thunstedt; Michael Schmutzer; Matthias P Fabritius; Jun Thorsteinsdottir; Mathias Kunz; Ruth Ruscheweyh; Andreas Straube Journal: Cephalalgia Date: 2022-03-02 Impact factor: 6.075