I hesitate to wade into this but guess I will anyway. The pro surgical patient advocacy sites do a great job in many ways but at the same time do a huge disservice to patients and are terribly misleading. Sadly many of those myths were continued on this site until it was reviewed by a group of medical professionals. I understand many have a favorite surgeon and that the group of patients here is not fully representative of Chiari patients in general.
While it is true that the only way to partially reverse a chiari malformation is surgical, the harsh reality is that out of 100 patients with a Chiari only 20 will ever require surgery. Only 14 will be helped of the remaining 3 will stay the same and 3 will get worse. That doesn't mean I'm pro surgery or antisurgery. It means that out of 100 patients with Chiari 86 will only get relief and treatment from a neurologist not to mention the 14 will need followup by a neurologist.
While the only way to correct the malformation and possible future damage, the concept of chiari being best treated by surgical intervention simply is not true. There are many medical interventions and treatment for "chiari headaches" The chain of events leading to a "Chiari Headache" is as individual as the patient themselves.
The typical headache that occurs in Chiari I patients is occipital pain associated with valsalva maneuvers (coughing, sneezing, lifting, etc.) The main challenge is to differentiate between primary headaches such as migraines or tension pain, and headaches due to typical posterior fossa syndrome. Obtaining a detailed history is the most important factor that helps in obtaining the correct pain diagnosis.While “Chiari” headaches often resolve with surgery IF that is the only thing going on. They will frequently also get worse with surgery if its syrinx pain. “Chiari” headaches may coexist with migraine headaches, in which case unless the surgery may or may not be a reasonable trade off.
The ONLY medical professional with the experience and training to make the call is a neurologist. Keep in mind that Chiari is not a rare condition and that 86% of chiari patients will not get help from a surgeon.
A treatment trial with a triptan (there are many) generally will answer the question of whats next. Tha'ts what was proposed by the "idiot" neurologist. It is not only reasonable but generally required by the better surgeons with the higher sucess rates. All the MRIs whether CINE or not can't answer the question. there is only ONE way of knowing for certain whether headaches are caused by CSH flow issues (anything else is a guess) and that involves a very painful spinal puncture procedure.