Hi there are many with low lying tonsils and or Chiari and may never need surgery....and no meds, if ur Chiari is symptomatic and progressing will help.
U will need to have a CINE MRI to determine if u have a CSF obstruction, if so a syrinx can form....if u already have a syrinx, then u can develop perm nerve damage....so, no having surgery is not always an option,
Pre-surgery, there were no medications that helped me. Post-surgery, there have been no medications that helped me. Advil and ice have been the most relief I can get (that and rest). I did have minor relief with muscle relaxer - carisoprodol - but it wasn't significant enough relief for me to decide it was worth taking regularly.
I'm currently trying Topamax and will see where I go from here. . . as of now, my headaches do seem to be of less severity, but they're still there. It doesn't help the pressure or the "vice-grip" feeling of the headache, just the pain aspect. It also doesn't help the other symptoms of numbness, pins & needless, weakness, dizziness, nausea, confusion, cognitive decline, etc. I've just completed 2 weeks today, though, so I don't have a true understanding of how well it will work for me.
Best wishes,
Annie