chronic headache or chiari?

[penchop]

my 13 year old daughter has had a chronic headache (24/7) since a flu in jan 08.  have seen neurology and tried 4 meds without improvement.  an mri showed an arnold chiari malformation of 5mm and spine is ok.  no one seems to have any suggestions as to what to do next and are not sure what is actually causing the headache.   we have been put on a 'wait and see' plan.  she is tired of the pain and its interference into her daily life.  any suggestions on how to further determine whether the headache is from the virus or the chiari?

[Dr Santos]

Hi,
Cine MRI's are sometimes ordered to help doctors determine the amount of CSF flow through the foramen magnum. This is useful in cases of "borderline" Chiari Malformations, if decompression is needed or in demonstrating other CSF blockages. This is highly debatable among physicians depending on the indications. One must know your daughter's complete history and results of all examination done to be able to justify if this MRI can be done. Another option is to get  another opinion. But it is never wrong to stop looking for answers.  Biofeedback and hypnosis are also worth looking into.

Take care and best regards.

[penchop]

Thanks you for the response.  The only symptom that would fall under Chiari is the headache and the neurologist mentioned that the virus probably stimulated a 'pain on' pattern and the neural signals are 'stuck'.  The neurologist and pediatritian have no more suggestions and have left us with the hope to only learn to manage her pain.  The pediatrician even had the gall to ask me when I was going to stop searching for answers!  Neither Dr. feel that a cine MRI is necessary but I would like to have one done to rule out any concern regarding fluid flow.  She has been introduced to yoga, meditation, and acupuncture to try to gain some control but the headache continues to interfere with life/school function and she is giving up hope getting relief.   Is demanding a cine MRI justified in this case?

[Dr Santos]

Hi,
How is your daughter? Chiari malformations (CM) are structural defects in the cerebellum wherein pressure can block the flow of cerebrospinal fluid. This causes a range of symptoms including dizziness, muscle weakness, numbness, vision problems, headache, and problems with balance and coordination. It is good that the spine is fine.  

Medical management is given for symptomatic relief while surgery is the treatment for structural problems. Virus infection usually resolve after a few days. The headache is more likely due to neurological causes. Talk to her doctors about this and inform them that the medications are not working. Alternative Medicine has also been proven to provide symptomatic relief. You can read more about this through this link:http://www.ninds.nih.gov/disorders/chiari/chiari.htm

Take care and do keep us posted.