Headache and Chiari I malformation in the pediatric population.

There has been disagreement regarding surgical intervention in treating pediatric patients with Chiari I malformation with headache as sole complaint. Therefore, we retrospectively reviewed our experience over a 6-year period, with patients less than 5 years of age (mean = 34.8 months) with radiographically confirmed Chiari I malformation. We identified 7 patients who presented with headaches as their only complaint. The headaches varied in location and severity. All patients were treated with posterior fossa decompression and syringosubarachnoid shunt when indicated. At follow-up, all patients were noted to have rapid clinical improvement (mean = 11.6 weeks) and remain asymptomatic. Our data suggest that patients less than 5 years of age with Chiari I malformation benefit from surgical decompression when presenting with a chief complaint of headache.