The impact of surgical and medical treatment on headaches in pediatric patients with Chiari malformation type I.

OBJECTIVE

This study seeks to report the incidence and type of headache in pediatric patients with Chiari malformation type I (CM-I) at a single institution as well as headache outcomes based on management strategy (surgical vs medical).

METHODS

A single-institution retrospective review from January 2003 to May 2020 identified all consecutive pediatric patients who were diagnosed with CM-I and who experienced headaches. Headaches were classified as typical, some features, and atypical CM-I headaches based on the International Classification of Headache Disorders criteria. Short- (< 6 months) and long-term (> 6 months) headache outcomes were classified as improvement or no improvement based on specific phrases in patient charts.

RESULTS

A total of 112 patients met inclusion criteria. Forty patients (35.7%) experienced typical CM-I headache, 42 (37.5%) experienced some features of a CM-I headache, and 30 (26.8%) experienced atypical CM-I headache. Of the 112 total patients, 48 (42.9%) received surgical treatment for CM-I and 64 (57.1%) were managed medically. The decision to perform surgery was made at the discretion of the treating neurosurgeon in discussion with the family, and was influenced by the severity of symptoms, the presence of other neurological findings on examination, and the presence of an associated syrinx. There was no statistically significant difference in headache improvement between surgical and medical treatment regardless of headache classification. Non-White race and the presence of a syrinx were statistically significant predictors of short-term headache improvement, and female gender was a statistically significant negative predictor of long-term headache improvement.

CONCLUSIONS

In this observational cohort of pediatric patients with CM-I, the authors found no difference in headache outcomes based on management strategy, regardless of the nature of the headache symptoms on presentation.