7.7 Headache attributed to Chiari malformation type I (CM1)

Identification: Sex/Age: Female, 28 years. Medical History: No known comorbidities. Family History: Negative for neurological diseases. History of Present Illness (HPI): Main symptom: Occipital/suboccipital headache for 6 months. Pain characteristics: Location: Bilateral occipital/suboccipital region. Character: Intense pressure or "stabbing" sensations. Intensity: 7-8/10. Duration: Minutes to hours, recurrent. Triggers: Coughing, sneezing, Valsalva maneuver (typical exacerbation). Improvement: Rest and simple analgesia (paracetamol). Associated symptoms: Occasional dizziness. Paresthesias in the upper limbs (mild/intermittent). No motor deficits or visual changes. Physical/Neurological Examination: General: Unremarkable. Neurological: Mild dysmetria on finger-to-nose test (right). Normal reflexes, no meningeal signs or papilledema. Preserved muscle strength and sensation. Complementary Exams: Magnetic Resonance Imaging of the Brain and Cervical Spine: Herniation of the cerebellar tonsils ≥5 mm below the foramen magnum. No associated hydrocephalus or syringomyelia.