Headaches and Arnold-Chiari syndrome: when to suspect and how to investigate.

Migraine and tension-type headache are common clinical problems, occurring even at a young age. When patients report headache as a symptom, it is necessary to exclude a secondary headache induced by an organic disease. Proper diagnosis and management of headache depends on a thorough history review and comprehensive clinical examination. A Chiari malformation is one organic cause that should not be overlooked. A thorough clinical screening is always recommended, including a complete neurological, mental status and physical examination. However, when the symptom pattern suggests a Chiari malformation, neuroimaging is warranted to identify correctly the pathologic condition and the most appropriate therapeutic approach. This paper reviews this condition, the signs and symptoms suggestive of its presence and how to arrive a the proper diagnosis.