43-Year-Old Man Suffers from Migraines for Over Two Decades, Root Cause Revealed as Internal Carotid Artery Aneurysm
In this article, we explore the medical journey of a 43-year-old male who experienced migraine-like symptoms for over 20 years. Initially attributed to stress during his college years, his condition persisted into adulthood. Upon further investigation, a serious underlying condition—an internal carotid artery aneurysm—was discovered. With timely diagnosis and a combination of medication and surgical intervention, the patient recovered successfully without complications.
Medical Profile
Patient: Male, 43 years oldDiagnosis: Migraine, internal carotid artery aneurysmHospital: Shandong Provincial Third HospitalVisit Date: November 2019Treatment: Pharmacological therapy (Aminopyrine Caffeine Tablets, Nimodipine Tablets) and endovascular coiling surgeryRecovery Time: 13 days of inpatient care with a follow-up visit one month post-dischargeOutcome: Full recovery with no adverse symptoms reported
Initial Consultation
The patient, a busy professional with frequent travel obligations, was encouraged by his wife to seek medical evaluation due to persistent headaches spanning more than two decades. His symptoms had recently worsened under increased work pressure, accompanied by hypertension, nausea, and vomiting. Rest provided minimal relief, especially after long hours of work or lack of sleep. He had no prior history of chronic illness, though he was a long-time smoker. Initially diagnosed with migraines, he found temporary relief using ibuprofen. Upon neurological examination, no significant abnormalities were detected, leading to an outpatient diagnosis of migraine. However, due to the chronic and recurring nature of his pain, further vascular imaging was recommended to rule out structural brain abnormalities. The patient agreed to undergo further testing.
Diagnostic Process and Treatment Plan
Blood tests revealed elevated uric acid and lipid levels. Further imaging, including brain MRI and MR angiography, identified an internal carotid artery aneurysm and multiple ischemic lesions in the brain. A standard brain CT scan showed no acute abnormalities but did indicate sinusitis. Additional tests, such as EEG and bubble study, came back normal, confirming the diagnosis of an internal carotid artery aneurysm.
To manage his symptoms, the patient was prescribed Aminopyrine Caffeine Tablets and Nimodipine Tablets to relieve pain and reduce cerebral vasospasm. By the third day of medication, his headache significantly improved. Given the aneurysm's size and the associated risk of rupture, endovascular coiling was recommended. After a detailed discussion regarding the procedure and potential risks, the patient underwent surgery. He recovered well with no complications and was discharged after 13 days of hospitalization.
Outcome and Follow-Up
Migraine headaches are often linked to central nervous system dysfunction, and many patients experience visual disturbances or sensitivity to sound and light before an episode. This patient's symptoms aligned with a migraine diagnosis, and pharmacological treatment offered rapid relief. However, the discovery of an aneurysm prompted further intervention. Post-surgery, he was advised to monitor his blood pressure regularly and maintain a healthy lifestyle. One month after discharge, during a follow-up visit, the patient was in good health—his blood pressure, lipids, and uric acid levels were within normal ranges, and he reported no recurrence of headaches.
Post-Treatment Recommendations
It is encouraging to see the patient's symptoms subside after treatment. Upon returning home, he was advised to rest in a quiet environment during any headache episodes, avoid strenuous physical activity, and manage emotional stress. Nutritionally, a low-salt, low-fat diet was recommended to help maintain stable blood pressure and cholesterol levels. Spicy, oily, and processed foods were discouraged. Consistent meal and medication schedules were emphasized to support overall recovery.
In daily life, reducing mental strain and incorporating moderate exercise can help prevent headaches. It is crucial to monitor both headache intensity and blood pressure. Should symptoms worsen or blood pressure spike, immediate medical attention is necessary. Additionally, a follow-up head and neck CTA scan was scheduled six months post-surgery to evaluate long-term vascular health.
Clinical Insight
This case underscores the importance of thorough medical evaluation, even when symptoms appear familiar or previously diagnosed. Headaches are common and often attributed to stress or migraines, but persistent or worsening symptoms should prompt further investigation. The patient's long-standing migraine diagnosis masked a life-threatening aneurysm. Early detection and treatment were critical to his successful recovery.
For individuals experiencing recurring headaches, it's essential not to dismiss symptoms without proper imaging and vascular assessment. Maintaining healthy lifestyle habits, monitoring blood pressure, cholesterol, and blood sugar levels, and staying physically active can significantly reduce the risk of cerebrovascular events. This case also highlights the importance of family support and proactive health management in preventing serious complications.