43-Year-Old Man Suffers from Migraines for Over Two Decades, Root Cause Turns Out to Be Internal Carotid Artery Aneurysm

In this case study, we explore the medical journey of a 43-year-old male who experienced chronic migraine-like symptoms for over 20 years. Initially attributed to stress and academic pressure during his college years, his recurring headaches persisted into adulthood. Upon further investigation at a medical facility, an unexpected underlying cause was discovered—an internal carotid artery aneurysm. With a combination of medication and minimally invasive surgery, the patient experienced a full recovery and is now symptom-free.

Patient Overview

Patient Age: 43 years oldGender: MaleDiagnosis: Migraine, internal carotid artery aneurysmTreatment Facility: Shandong Provincial Third HospitalTreatment Period: November 2019Treatment Approach: Pharmacological therapy (Aminopyrine Caffeine Tablets, Nimodipine) combined with endovascular coiling surgeryRecovery Timeline: 13-day hospitalization, followed by a one-month outpatient follow-up

Initial Consultation and Symptom History

The patient, a busy professional with frequent travel obligations, was encouraged by his wife to undergo a medical evaluation due to persistent headaches that had lasted more than two decades. The headaches had recently worsened, accompanied by symptoms such as hypertension, nausea, and vomiting. Rest and over-the-counter pain medications like ibuprofen provided only temporary relief. He had a history of smoking but no significant prior medical conditions.

Neurological examination showed no abnormal findings, and he was initially diagnosed with migraines. Given the chronic and recurring nature of his headaches, physicians recommended further diagnostic imaging to rule out structural brain abnormalities, including aneurysms or other vascular issues. The patient was cooperative and agreed to undergo a full cerebral vascular assessment.

Diagnostic Findings and Treatment Plan

During outpatient testing, blood work revealed elevated uric acid and lipid levels. Brain MRI and MR angiography identified an internal carotid artery aneurysm along with multiple ischemic lesions in the brain. A standard brain CT scan showed no acute abnormalities but did indicate signs of sinusitis. Further diagnostic tests, including EEG and bubble studies, came back normal, confirming the diagnosis of an internal carotid artery aneurysm.

To manage his pain and reduce vascular tension, the patient was prescribed Aminopyrine Caffeine Tablets and Nimodipine. His headache symptoms significantly improved within three days of starting medication. Due to the size of the aneurysm and its potential to rupture, a decision was made to proceed with endovascular coiling. After a thorough discussion of the procedure and associated risks, the patient underwent successful aneurysm embolization. He recovered well post-surgery and was discharged after a 13-day hospital stay.

Outcome and Follow-Up

Migraines are often linked to central nervous system dysfunction and can be triggered by sensory stimuli such as light or sound. Some patients experience visual disturbances or sensory auras before an attack. This patient's symptoms aligned with a migraine diagnosis, and his acute pain responded well to prescribed medication. However, the discovery of the aneurysm prompted additional intervention to prevent life-threatening complications.

At the one-month follow-up, the patient was asymptomatic, with stable blood pressure, normalized lipid levels, and reduced uric acid. His overall recovery was positive, and no complications were observed.

Post-Treatment Recommendations

After discharge, patients should adopt lifestyle changes to support long-term health and prevent recurrence. It's important to rest in a quiet environment during headache episodes, avoid strenuous activity, and maintain emotional stability. Dietary adjustments should focus on low-salt, low-fat meals rich in nutrients, while avoiding spicy, oily, or overly processed foods.

Consistency in medication and meal timing is crucial. To reduce migraine frequency, individuals should balance mental workload, avoid cognitive fatigue, and engage in regular physical exercise to improve overall wellness. Monitoring blood pressure and headache intensity is essential, and immediate medical attention should be sought if symptoms worsen or blood pressure spikes.

For patients who have undergone aneurysm treatment, regular follow-ups including head and neck CTA scans after six months are recommended to monitor vascular health and ensure no new abnormalities develop.

Clinical Insight and Final Thoughts

This case highlights the importance of thorough diagnostic evaluation, even in patients with a long-standing migraine diagnosis. Headaches are a common clinical complaint and can stem from a variety of conditions, some of which—like aneurysms—can be life-threatening if left untreated.

It's crucial not to dismiss persistent or worsening headaches as routine migraines without ruling out structural causes. Patients experiencing chronic or escalating head pain should seek comprehensive neurological evaluation. Preventive healthcare, including regular monitoring of blood pressure, cholesterol, and glucose levels, plays a key role in early detection and disease prevention.

For professionals engaged in mentally demanding work, maintaining a balanced lifestyle with proper nutrition, rest, and physical activity is essential. Strengthening overall health can significantly reduce the risk of vascular events and improve quality of life.