Chiari Malformation: A Potential Cause of Headaches in Brass Players

Abstract

There has been little attention in the literature to the ailments of horn players and more specifically the etiology of what has been reported by brass players as recurring headaches that may be distinctly related to playing practices. The following report illustrates the case of a 58-year-old male, a keen amateur musician, who presented with progressive Valsalva headaches. He reported that his symptoms became worse when playing the cornet, to the extent that, at presentation, he could no longer play for more than 5 minutes. After imaging, he was diagnosed with Chiari type 1 malformation. This case study looks at the relationship between the patient’s music activity and his intracranial pressure related to Valsalva manoeuvres, and furthermore explores the possible contributory link to his Chiari malformation. The occurrence of significant headaches in brass players, in particular when playing in the higher register, should prompt consideration of medical attendance and screening with MR scanning for Chiari malformation.