{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:15:41Z","timestamp":1772828141765,"version":"3.50.1"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n 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).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.2.peds24356","type":"journal-article","created":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T22:54:16Z","timestamp":1746831256000},"page":"201-207","source":"Crossref","is-referenced-by-count":0,"title":["The impact of surgical and medical treatment on headaches in pediatric patients with Chiari malformation type I"],"prefix":"10.3171","volume":"36","author":[{"given":"Benjamin T.","family":"Lynch","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Boston Children\u2019s Hospital, Boston; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma K.","family":"Hartman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Boston Children\u2019s Hospital, Boston; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madeline B.","family":"Karsten","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Boston Children\u2019s Hospital, Boston; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna L.","family":"Slingerland","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Boston Children\u2019s Hospital, Boston; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven J.","family":"Staffa","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark R.","family":"Proctor","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Boston Children\u2019s Hospital, Boston; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph P.","family":"Cravero","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"J Neurosurg Pediatr","first-page":"375","article-title":"Outcomes in pediatric patients with Chiari malformation Type I followed up without surgery","volume":"7","author":"Benglis D Jr","year":"2011","unstructured":"Benglis D Jr, Covington D, Bhatia R, Outcomes in pediatric patients with Chiari malformation Type I followed up without surgery. J Neurosurg Pediatr. 2011;7(4):375\u2013379."},{"issue":"4","key":"b2","series-title":"Childs Nerv Syst","first-page":"1185","article-title":"Natural history of Chiari I malformation in children: a retrospective analysis","volume":"37","author":"Carey M","year":"2021","unstructured":"Carey M, Fuell W, Harkey T, Albert GW. Natural history of Chiari I malformation in children: a retrospective analysis. Childs Nerv Syst. 2021;37(4):1185\u20131190."},{"key":"b3","first-page":"213","article-title":"Chiari malformation type 1: a systematic review of natural history and conservative management","volume":"104","author":"Langridge B","year":"2017","unstructured":"Langridge B, Phillips E, Choi D. Chiari malformation type 1: a systematic review of natural history and conservative management. World Neurosurg. 2017;104:213\u2013219."},{"issue":"2","key":"b4","series-title":"Clin J Sport Med","first-page":"133","article-title":"Risk of athletes with Chiari malformations suffering catastrophic injuries during sports participation is low","volume":"25","author":"Meehan WP III","year":"2015","unstructured":"Meehan WP III, Jordaan M, Prabhu SP, Carew L, Mannix RC, Proctor MR. Risk of athletes with Chiari malformations suffering catastrophic injuries during sports participation is low. Clin J Sport Med. 2015;25(2):133\u2013137."},{"issue":"3","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"179","article-title":"The natural history of the Chiari Type I anomaly","volume":"2","author":"Novegno F","year":"2008","unstructured":"Novegno F, Caldarelli M, Massa A, The natural history of the Chiari Type I anomaly. J Neurosurg Pediatr. 2008;2(3):179\u2013187."},{"issue":"3","key":"b6","series-title":"J Neurosurg Pediatr","first-page":"343","article-title":"Natural and surgical history of Chiari malformation Type I in the pediatric population","volume":"17","author":"Pomeraniec IJ","year":"2016","unstructured":"Pomeraniec IJ, Ksendzovsky A, Awad AJ, Fezeu F, Jane JA Jr. Natural and surgical history of Chiari malformation Type I in the pediatric population. J Neurosurg Pediatr. 2016;17(3):343\u2013352."},{"issue":"2","key":"b7","series-title":"J Neurosurg Pediatr","first-page":"214","article-title":"Natural history of Chiari malformation Type I following decision for conservative treatment","volume":"8","author":"Strahle J","year":"2011","unstructured":"Strahle J, Muraszko KM, Kapurch J, Bapuraj JR, Garton HJ, Maher CO. Natural history of Chiari malformation Type I following decision for conservative treatment. J Neurosurg Pediatr. 2011;8(2):214\u2013221."},{"issue":"2","key":"b8","series-title":"J Neurosurg Pediatr","first-page":"161","article-title":"Pediatric and adult Chiari malformation Type I surgical series 1965-2013: a review of demographics, operative treatment, and outcomes","volume":"15","author":"Arnautovic A","year":"2015","unstructured":"Arnautovic A, Splavski B, Boop FA, Arnautovic KI. Pediatric and adult Chiari malformation Type I surgical series 1965-2013: a review of demographics, operative treatment, and outcomes. J Neurosurg Pediatr. 2015;15(2):161\u2013177."},{"issue":"suppl 1","key":"b9","series-title":"Neurol Sci","first-page":"95","article-title":"Chiari malformation-related headache: outcome after surgical treatment","volume":"38","author":"Beretta E","year":"2017","unstructured":"Beretta E, Vetrano IG, Curone M, Chiari malformation-related headache: outcome after surgical treatment. Neurol Sci. 2017;38(suppl 1):95-98."},{"issue":"9","key":"b10","series-title":"Cephalalgia","first-page":"879","article-title":"Headache characteristics and postoperative course in Chiari I malformation","volume":"42","author":"Thunstedt DC","year":"2022","unstructured":"Thunstedt DC, Schmutzer M, Fabritius MP, Headache characteristics and postoperative course in Chiari I malformation. Cephalalgia. 2022;42(9):879\u2013887."},{"issue":"3","key":"b11","series-title":"Arch Dis Child","first-page":"238","article-title":"Headache outcomes in children undergoing foramen magnum decompression for Chiari I malformation","volume":"102","author":"Raza-Knight S","year":"2017","unstructured":"Raza-Knight S, Mankad K, Prabhakar P, Thompson D. Headache outcomes in children undergoing foramen magnum decompression for Chiari I malformation. Arch Dis Child. 2017;102(3):238\u2013243."},{"issue":"24 Suppl 1","key":"b12","series-title":"Cephalalgia","first-page":"9","article-title":"The International Classification of Headache Disorders: 2nd edition.","year":"2004","unstructured":"Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24 Suppl 1:9-160."},{"issue":"10","key":"b13","series-title":"J Orthop Sports Phys Ther","first-page":"702","article-title":"Musculoskeletal pain in children and adolescents: a way forward","volume":"47","author":"Kamper SJ","year":"2017","unstructured":"Kamper SJ, Williams CM. Musculoskeletal pain in children and adolescents: a way forward. J Orthop Sports Phys Ther. 2017;47(10):702\u2013704."},{"issue":"10","key":"b14","series-title":"Spine (Phila Pa 1976)","first-page":"1132","article-title":"The prevalence of low back pain among children and adolescents. A nationwide, cohort-based questionnaire survey in Finland","volume":"22","author":"Taimela S","year":"1997","unstructured":"Taimela S, Kujala UM, Salminen JJ, Viljanen T. The prevalence of low back pain among children and adolescents. A nationwide, cohort-based questionnaire survey in Finland. Spine (Phila Pa 1976). 1997;22(10):1132\u20131136."},{"issue":"12","key":"b15","series-title":"Pain","first-page":"2729","article-title":"The epidemiology of chronic pain in children and adolescents revisited: a systematic review","volume":"152","author":"King S","year":"2011","unstructured":"King S, Chambers CT, Huguet A, The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain. 2011;152(12):2729\u20132738."},{"issue":"4","key":"b1","series-title":"J Neurosurg Pediatr","first-page":"375","article-title":"Outcomes in pediatric patients with Chiari malformation Type I followed up without surgery","volume":"7","author":"Benglis D Jr","year":"2011","unstructured":"Benglis D Jr, Covington D, Bhatia R, Outcomes in pediatric patients with Chiari malformation Type I followed up without surgery. J Neurosurg Pediatr. 2011;7(4):375\u2013379."},{"issue":"4","key":"b2","series-title":"Childs Nerv Syst","first-page":"1185","article-title":"Natural history of Chiari I malformation in children: a retrospective analysis","volume":"37","author":"Carey M","year":"2021","unstructured":"Carey M, Fuell W, Harkey T, Albert GW. Natural history of Chiari I malformation in children: a retrospective analysis. Childs Nerv Syst. 2021;37(4):1185\u20131190."},{"key":"b3","first-page":"213","article-title":"Chiari malformation type 1: a systematic review of natural history and conservative management","volume":"104","author":"Langridge B","year":"2017","unstructured":"Langridge B, Phillips E, Choi D. Chiari malformation type 1: a systematic review of natural history and conservative management. World Neurosurg. 2017;104:213\u2013219."},{"issue":"2","key":"b4","series-title":"Clin J Sport Med","first-page":"133","article-title":"Risk of athletes with Chiari malformations suffering catastrophic injuries during sports participation is low","volume":"25","author":"Meehan WP III","year":"2015","unstructured":"Meehan WP III, Jordaan M, Prabhu SP, Carew L, Mannix RC, Proctor MR. Risk of athletes with Chiari malformations suffering catastrophic injuries during sports participation is low. Clin J Sport Med. 2015;25(2):133\u2013137."},{"issue":"3","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"179","article-title":"The natural history of the Chiari Type I anomaly","volume":"2","author":"Novegno F","year":"2008","unstructured":"Novegno F, Caldarelli M, Massa A, The natural history of the Chiari Type I anomaly. J Neurosurg Pediatr. 2008;2(3):179\u2013187."},{"issue":"3","key":"b6","series-title":"J Neurosurg Pediatr","first-page":"343","article-title":"Natural and surgical history of Chiari malformation Type I in the pediatric population","volume":"17","author":"Pomeraniec IJ","year":"2016","unstructured":"Pomeraniec IJ, Ksendzovsky A, Awad AJ, Fezeu F, Jane JA Jr. Natural and surgical history of Chiari malformation Type I in the pediatric population. J Neurosurg Pediatr. 2016;17(3):343\u2013352."},{"issue":"2","key":"b7","series-title":"J Neurosurg Pediatr","first-page":"214","article-title":"Natural history of Chiari malformation Type I following decision for conservative treatment","volume":"8","author":"Strahle J","year":"2011","unstructured":"Strahle J, Muraszko KM, Kapurch J, Bapuraj JR, Garton HJ, Maher CO. Natural history of Chiari malformation Type I following decision for conservative treatment. J Neurosurg Pediatr. 2011;8(2):214\u2013221."},{"issue":"2","key":"b8","series-title":"J Neurosurg Pediatr","first-page":"161","article-title":"Pediatric and adult Chiari malformation Type I surgical series 1965-2013: a review of demographics, operative treatment, and outcomes","volume":"15","author":"Arnautovic A","year":"2015","unstructured":"Arnautovic A, Splavski B, Boop FA, Arnautovic KI. Pediatric and adult Chiari malformation Type I surgical series 1965-2013: a review of demographics, operative treatment, and outcomes. J Neurosurg Pediatr. 2015;15(2):161\u2013177."},{"issue":"suppl 1","key":"b9","series-title":"Neurol Sci","first-page":"95","article-title":"Chiari malformation-related headache: outcome after surgical treatment","volume":"38","author":"Beretta E","year":"2017","unstructured":"Beretta E, Vetrano IG, Curone M, Chiari malformation-related headache: outcome after surgical treatment. Neurol Sci. 2017;38(suppl 1):95-98."},{"issue":"9","key":"b10","series-title":"Cephalalgia","first-page":"879","article-title":"Headache characteristics and postoperative course in Chiari I malformation","volume":"42","author":"Thunstedt DC","year":"2022","unstructured":"Thunstedt DC, Schmutzer M, Fabritius MP, Headache characteristics and postoperative course in Chiari I malformation. Cephalalgia. 2022;42(9):879\u2013887."},{"issue":"3","key":"b11","series-title":"Arch Dis Child","first-page":"238","article-title":"Headache outcomes in children undergoing foramen magnum decompression for Chiari I malformation","volume":"102","author":"Raza-Knight S","year":"2017","unstructured":"Raza-Knight S, Mankad K, Prabhakar P, Thompson D. Headache outcomes in children undergoing foramen magnum decompression for Chiari I malformation. Arch Dis Child. 2017;102(3):238\u2013243."},{"issue":"24 Suppl 1","key":"b12","series-title":"Cephalalgia","first-page":"9","article-title":"The International Classification of Headache Disorders: 2nd edition.","year":"2004","unstructured":"Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24 Suppl 1:9-160."},{"issue":"10","key":"b13","series-title":"J Orthop Sports Phys Ther","first-page":"702","article-title":"Musculoskeletal pain in children and adolescents: a way forward","volume":"47","author":"Kamper SJ","year":"2017","unstructured":"Kamper SJ, Williams CM. Musculoskeletal pain in children and adolescents: a way forward. J Orthop Sports Phys Ther. 2017;47(10):702\u2013704."},{"issue":"10","key":"b14","series-title":"Spine (Phila Pa 1976)","first-page":"1132","article-title":"The prevalence of low back pain among children and adolescents. A nationwide, cohort-based questionnaire survey in Finland","volume":"22","author":"Taimela S","year":"1997","unstructured":"Taimela S, Kujala UM, Salminen JJ, Viljanen T. The prevalence of low back pain among children and adolescents. A nationwide, cohort-based questionnaire survey in Finland. Spine (Phila Pa 1976). 1997;22(10):1132\u20131136."},{"issue":"12","key":"b15","series-title":"Pain","first-page":"2729","article-title":"The epidemiology of chronic pain in children and adolescents revisited: a systematic review","volume":"152","author":"King S","year":"2011","unstructured":"King S, Chambers CT, Huguet A, The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain. 2011;152(12):2729\u20132738."}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/36\/2\/article-p201.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/36\/2\/article-p201.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/36\/2\/article-p201.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T13:47:15Z","timestamp":1772804835000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/36\/2\/article-p201.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,1]]},"references-count":30,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2025.2.peds24356","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,1]]}}}