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08 Jun 2011

Chiari 1, Tarlov cysts and headache
Dear Doc

I have an Arnold-Chiari 1 with 5 mm herniation and am suffering from headaches, neckpain and facial pain more often the last few months. It is recently on a weekly basis that I get the headaches. I also have large Tarlov cyst in the thoracic area with paresthesis and weakness in both my hands. Pain is not relieved by Synap Forte, but by Voltaren injections. How do I know that it is due to the Chiari and/or Tarlov cysts??

Answer 2,498 views
Headache expert
Headache expert

01 Jan 0001

Dear Racoon,

Headaches may well be associated with Arnold-Chiari malformations, but there are countless people without these malformations that have the same symptoms. It is also unlikely that the problem is due to the Tarlov cysts. The best way to be sure is to have the pain properly diagnosed - it is possible in most headache patients to pinpoint the source of the pain.To get to the root of the problem, you need what is called a “multidisciplinary assessment”, which should include a neurological examination to rule out any serious underlying condition. There are so many different structures in the head and neck, all of which can be involved in the headache process, that no single specialist can have all the knowledge necessary to make a comprehensive assessment and diagnosis. For instance, a neurologist will examine the brain and nervous system, a physiotherapist will look at the muscles, a dentist will examine the teeth etc. For this reason, the “multidisciplinary assessment” combines and integrates the expertise of different specialists who would normally treat headache patients in isolation, into a single more comprehensive body of knowledge. This enables the different members of the team to provide a co-ordinated treatment plan, so that all the contributing factors are addressed.

This assessment must include a thorough examination of the head and neck muscles to determine the presence of abnormal tension, and of the external carotid vasculature to determine whether there is an arterial element to the pain.

Headache sufferers often have a poor Quality of Life due to the constant pain and associated symptoms. For a free assessment of how your headaches are affecting your Quality of Life, click on

This information has been supplied and checked by the multidisciplinary team of specialists at The Headache Clinic, in association with The International Headache Society and the South African Institute of Headache and Migraine Science. For consultation with these specialists, call The Headache Clinic (Cape Town, Durban, Johannesburg) on 0861 678 911.
The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical examination, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.
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