Chiari Malformation: The Overlooked Diagnosis Behind Chronic Headaches, Nerve Pain, and Balance Issues

Rethinking Chiari: Why So Many Patients Are Misdiagnosed or Left Without Answers

Too often, patients suffering from daily headaches, unexplained nerve symptoms, balance problems, or even scoliosis are told their MRI findings are “incidental.” Many have spent years feeling dismissed or misdiagnosed, cycling through specialists, and questioning whether their symptoms are “all in their head.” At Movability, we want you to know—you’re not imagining it. Your symptoms are real. And in many cases, they finally make sense when we look through the lens of Chiari malformation.

Chiari malformation affects an estimated 1 in 1,000 people and is more impactful than most people realize—yet it often goes undiagnosed or misunderstood for years.

At Movability, we regularly see patients who have spent years searching for answers. In many cases, their symptoms—and their suffering—make perfect sense once we take a closer look at their anatomy, biomechanics, and nervous system function.

These mislabels can delay proper treatment for years, compounding the physical and emotional toll. We often see patients who were told their symptoms were psychosomatic, only to later discover a clear anatomical cause.

What Is Chiari Malformation?

Chiari malformation (CM) refers to a structural defect in which part of the brain—the cerebellar tonsils—descends below the base of the skull into the spinal canal. This herniation can compress the brainstem, restrict cerebrospinal fluid (CSF) flow, and stretch the spinal cord, leading to a wide variety of symptoms that vary depending on the degree and direction of the impaction.

A Breakdown of the Types

Chiari malformations are classified into several types based on anatomical features and severity. Here’s a deeper look at each:

Chiari I Malformation

  • Description: Involves the downward herniation of the cerebellar tonsils through the foramen magnum by more than 3–5 mm.

  • Onset: Often diagnosed in late childhood, adolescence, or adulthood—sometimes incidentally.

  • Symptoms: Occipital headaches (worse with straining), neck pain, dizziness, balance issues, numbness in arms/hands, tinnitus, sleep apnea, or syringomyelia (fluid-filled spinal cyst).

  • Imaging: MRI typically shows tonsillar descent without other congenital brain defects. Syrinx may be present.

  • Treatment: Often conservative unless symptoms are severe or a syrinx is present. Surgical decompression is common.

Chiari 1.5 Malformation

  • Description: Similar to Type I but with additional downward displacement of the brainstem (medulla), not just the cerebellar tonsils.

  • Onset: Can present earlier and with more severe symptoms than Type I.

  • Symptoms: Includes more brainstem-related issues—swallowing difficulty, hoarseness, cranial nerve signs, apnea.

  • Imaging: MRI shows both cerebellar tonsil and brainstem descent, with often more crowding of the foramen magnum.

  • Treatment: Surgery is more often required, and sometimes fusion is considered if instability is present.

Chiari II Malformation (Arnold–Chiari Malformation)

  • Description: A more severe form that includes herniation of the cerebellum, brainstem, and fourth ventricle through the foramen magnum. It is almost always associated with a myelomeningocele (open spina bifida).

  • Onset: Detected prenatally or at birth.

  • Symptoms: Breathing problems, swallowing difficulties, weakness in the arms, nystagmus, and hydrocephalus.

  • Imaging: “Banana-shaped” cerebellum, small posterior fossa, myelomeningocele, often enlarged ventricles.

  • Treatment: Closure of the spinal defect after birth, CSF shunting for hydrocephalus, and posterior fossa decompression if symptoms persist.

Chiari III Malformation

  • Description: Extremely rare and severe. Involves herniation of the cerebellum and brainstem into a high cervical or occipital encephalocele (a sac-like protrusion through a skull defect).

  • Onset: At birth; often identified prenatally.

  • Symptoms: Severe neurological impairment, seizures, weakness, and high mortality.

  • Imaging: MRI shows encephalocele with brain tissue, brainstem herniation, and additional abnormalities.

  • Treatment: Surgical correction is complex; prognosis is generally poor even with intervention.

Chiari IV Malformation

  • Description: Involves cerebellar hypoplasia or aplasia—meaning the cerebellum is underdeveloped or absent. It is not a herniation disorder like the others.

  • Onset: Present at birth.

  • Symptoms: Severe motor and coordination deficits, intellectual disability, seizures.

  • Imaging: MRI shows missing or underdeveloped cerebellum with a malformed posterior fossa.

  • Treatment: Supportive care only; prognosis is typically poor and often incompatible with life.

Chiari 0 Malformation

  • Description: Patients present with symptoms and sometimes a syrinx, but have minimal or no tonsillar herniation. It’s believed to be due to CSF flow obstruction or tight posterior fossa despite normal-appearing anatomy.

  • Onset: Can occur at any age.

  • Symptoms: Headaches, sensory changes, syringomyelia-like symptoms.

  • Imaging: May show minimal descent or none, but cine MRI reveals poor CSF flow.

  • Treatment: Posterior fossa decompression is often successful in improving symptoms and reducing syrinx.

The Anatomy Behind the Symptoms: Why Chiari Is a Whole-Body Problem

At first glance, Chiari malformation appears to be a localized issue at the craniocervical junction (where the skull meets the top of the spine). But in reality, it’s a condition with system-wide effects driven by structural, neurological, and biomechanical relationships throughout the body. To understand how Chiari affects everything from headaches to hand numbness, we must examine the core anatomical systems involved:

1. Craniocervical Junction and Foramen Magnum

This is where the skull transitions into the upper cervical spine. The foramen magnum is the opening through which the brainstem connects to the spinal cord. In Chiari, the cerebellar tonsils descend through this space, causing crowding and compression. This impingement can disrupt cranial nerve function and impair blood and CSF flow.

2. Cerebellum and Brainstem

The cerebellum controls balance, motor coordination, and fine-tuning of movement. The brainstem regulates vital autonomic functions (breathing, heart rate, digestion) and houses many cranial nerve nuclei. Even slight compression here can lead to symptoms as diverse as dizziness, swallowing difficulty, hoarseness, or breathing irregularities.

3. Cerebrospinal Fluid (CSF) System

CSF circulates around the brain and spinal cord, cushioning it and maintaining pressure equilibrium. The Chiari herniation often blocks or disturbs CSF flow, which can increase intracranial pressure or create syringomyelia (a fluid-filled cavity within the spinal cord). CSF flow also plays a role in waste clearance (glymphatic system), so Chiari may indirectly affect cognition or energy levels.

4. Spinal Cord and Dural Tension

The spinal cord is suspended from the brainstem to the sacrum and is encased in the dura mater. Tension anywhere along this axis—from foot and pelvic asymmetry to suboccipital muscle hypertonicity—can create a traction effect that exacerbates Chiari-related compression. This is especially relevant when the spinal cord is already displaced or under strain from the herniated cerebellar tissue.

5. Myodural Bridge and Cervical Myofascial System

The suboccipital muscles (especially rectus capitis posterior minor) attach directly to the dura mater through the myodural bridge. This link means that tightness in these small muscles—common in forward head posture or jaw dysfunction—can directly transmit mechanical tension to the dura and brainstem, worsening Chiari symptoms. Fascial continuity extends this tension all the way down the posterior chain, linking cervical strain to foot and pelvic mechanics.

6. Posterior Fossa Anatomy

In many Chiari patients, the bony space at the base of the skull (posterior fossa) is abnormally small or underdeveloped. This creates a volumetric mismatch—there simply isn’t enough space for the cerebellum to sit comfortably. This congenital architectural problem is why Chiari is often a structural diagnosis rather than one caused by trauma or degeneration. Recognizing the posterior fossa’s size and shape is essential for evaluating surgical need and for understanding why even “mild” tonsillar descent can still be highly symptomatic.

7. Integration with Musculoskeletal and Postural Systems

Because of the fascial and neurological connections between the head, neck, spine, and pelvis, Chiari symptoms often present in musculoskeletal ways—tight hamstrings, thoracic stiffness, TMJ dysfunction, scapular dyskinesis. These are not coincidental. Biomechanical compensation patterns can amplify neural tension and further compromise CSF dynamics. That’s why Chiari must be assessed—and treated—as a full-body condition.

Symptoms That Don’t Seem Related—But Are

Chiari malformation is known as a “great imitator” because it can mimic or overlap with dozens of other diagnoses. Its system-wide effects extend far beyond the head and neck, impacting multiple organ systems due to disrupted nervous system signaling, altered CSF flow, and tension on neural and fascial structures. Patients may present with a wide array of symptoms that appear unrelated but are actually rooted in the same underlying condition:

Neurological and Sensory Symptoms

  • Occipital headaches, often worsened by coughing, sneezing, or straining

  • Numbness, tingling, or temperature sensitivity in the hands, arms, or face

  • Dizziness, vertigo, or lightheadedness when standing or turning the head

  • Muscle weakness, clumsiness, or impaired coordination

  • Visual disturbances: blurred vision, double vision, or difficulty tracking

  • Tinnitus or ear pressure/fullness, especially with posture changes

  • Cognitive dysfunction or “brain fog” from impaired CSF clearance and brainstem stress

Autonomic Nervous System Dysregulation

  • Heart palpitations or bradycardia

  • Respiratory irregularities, including sleep apnea or breath-holding spells

  • Gastrointestinal changes: constipation, bloating, or nausea

  • Temperature dysregulation or excessive sweating

  • Fatigue that feels neurological rather than muscular in nature

Musculoskeletal Compensation Patterns

  • Persistent neck and upper back tension, often unresponsive to typical treatments

  • Forward head posture and scapular instability

  • Thoracic or lumbar stiffness as the body braces to stabilize a compressed craniocervical junction

  • Leg tightness, pelvic asymmetry, or scoliosis—especially in pediatric patients with syringomyelia

Oropharyngeal and Facial Dysfunction

  • Difficulty swallowing, chronic throat clearing, or coughing during meals

  • Hoarseness, vocal fatigue, or slurred speech

  • TMJ pain or jaw clenching

  • Facial numbness or trigeminal nerve irritation

Mental and Emotional Effects

  • Anxiety or panic-like symptoms triggered by dysautonomia

  • Depression or emotional lability linked to chronic neurological strain

  • Sensory overload or difficulty concentrating in stimulating environments

These system-wide effects make Chiari difficult to recognize—and easy to misattribute to multiple unrelated conditions. But when a patient’s seemingly disconnected symptoms are reframed in the context of brainstem compression, spinal cord traction, and disturbed CSF flow, the puzzle begins to come together.

Movability’s Integrative, Root-Cause Approach to Chiari Malformation

If you or someone you love is living with Chiari malformation—or even suspects it—your first step must be a Complex Case Initial Assessment with Dr. Sina Yeganeh. As the clinical director of Movability, Dr. Sina has spent years developing advanced protocols for assessing and managing Chiari, going far beyond what traditional models offer.

Many of the techniques used in our clinic for Chiari-related neural tension, postural release, and whole-body decompression have been designed by Dr. Sina himself, based on his extensive experience treating patients with this condition. This is not a one-size-fits-all diagnosis, and it demands a nuanced, biomechanically and neurologically precise evaluation.

Before anything is delegated to our multidisciplinary team, Dr. Sina must perform a thorough, full-body diagnostic workup to determine the nature of the Chiari presentation, its contributing factors, and the safest, most effective path forward. Only after this initial assessment will an individualized treatment plan be created—often involving collaboration across physiotherapy, manual therapy, naturopathic care, and more.

A Full-Body Structural and Neurological Analysis

We evaluate everything from foot mechanics and pelvic alignment to jaw tension and visual integration, such as binocular vision dysfunction or convergence issues, which can alter head posture and proprioception, contributing to chronic neck tension and imbalance.

Collaborative Multidisciplinary Care

Our practitioners work together—chiropractors, physiotherapists, naturopaths, acupuncturists, and more—to combine manual therapy, neuromuscular re-education, and individualized rehabilitation. We focus on reducing neural tension, optimizing CSF dynamics, and addressing the anatomical and functional causes of the compression.

Customized Therapy Plans

Whether patients are surgical candidates or not, we build tailored programs that may include:

  • Neuromuscular release (from feet upward)

  • Cervical decompression through postural integration

  • Tongue, jaw, and breathing re-patterning

  • Pelvic floor and diaphragm coordination

  • Acupuncture for autonomic balance and pain modulation

We frequently see patients with stories like this one. For example, a 32-year-old woman with Chiari I came to us after years of being told her MRI findings were “insignificant.” She had daily neck pain, dizziness, and brain fog that affected her work and relationships. Through a combination of foot-to-cranium neuromuscular release, jaw and tongue retraining, and posture integration, she began to feel noticeable relief within weeks. Her balance improved. Her energy returned. And for the first time in years, she felt like her body made sense again.

We also coordinate with neurosurgeons when surgical decompression is required, ensuring patients are optimized both before and after surgery.

A Smarter Path Forward for Chiari Patients

Chiari malformation isn’t just a structural issue—it’s a systems problem involving neurology, biomechanics, and physiology.

We know that for many patients, the hardest part isn’t the pain—it’s not being believed. Being told your symptoms are disconnected or insignificant can leave you feeling helpless. At Movability, we listen closely, investigate thoroughly, and treat compassionately. You deserve care that validates your experience and addresses the whole picture.

Treating Chiari effectively requires more than just imaging and surgery. It requires a team that sees the full picture and knows how to correct it.

At Movability, we don’t settle for managing symptoms. We uncover the root cause, untangle the mechanical and neurological stressors, and help patients reclaim their function and quality of life.

Contact Movability today to book a comprehensive assessment and experience our results-driven approach.

Sina Yeganeh