“Chiari malformation” (CM) refers to several rare malformations of certain parts of the brain (usually the cerebellum, sometimes also the brainstem). Although these malformations are present from birth, the most common types may not cause symptoms until adulthood, and typical symptoms include headaches, visual problems (such as blurry vision), dizziness, and difficulty swallowing. The diagnosis may be suspected from findings on physical examination, but confirmation with a brain MRI is appropriate. Even if a patient’s brain MRI shows findings compatible with CM, it is still reasonable to search for other, more common causes of these symptoms, and if that search does not show any more likely explanation, then CM is probably the correct diagnosis. Some clinicians may consider a trial of medication for certain symptoms. If a patient’s symptoms are very intrusive, or if they do not respond to medication, then referral to neurosurgery is appropriate.