According to magnetic resonance imaging data, about 1% of adults have Chiari malformation type I, but only 0.01—0.04% of them have clinical manifestations. The main sign is headache. At the same time, prevalence of primary headache in these patients is the same as in general population. In this regard, it is sometimes necessary to differentiate etiology of pain syndrome for correct treatment strategy. We present successful treatment of a patient with secondary headache following Chiari malformation type I, as well as tension headache and drug-induced pain.