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'Worst Headache': When It's Time For Emergency Care

“The worst headache of your life” could be your sign to seek emergency, lifesaving medical care, says neurologist Esteban Cheng-Ching, MD.

A severe headache could be a primary symptom of a brain aneurysm that is rupturing, or about to. 

A brain or cerebral aneurysm is a thin, weak spot in the wall of an artery, where blood pools, eventually forcing the artery to bulge. Like a stretching balloon, an aneurysm weakens as it enlarges.

Many Aneuryms Go Undetected, But…

Smaller aneurysms can go undetected, causing no symptoms. Most people with aneurysms are unaware they have them.

Aneurysms are typically discovered when symptoms occur. And in some cases, they’re discovered by accident, when a doctor finds one through a CT or MRI scan conducted to evaluate an unrelated medical condition, Dr. Ching said.

Symptoms may develop when a growing aneurysm puts pressure on surrounding brain tissue and nerves. In some cases, a small amount of blood may leak from the aneurysm — a “sentinel hemorrhage.” This may cause symptoms such as headaches, nausea and vomiting and, in some cases, vision loss or double vision.

These symptoms are reason to seek medical attention immediately to have the problem diagnosed and treated. 

Neurologist Bryan Ludwig, MD, explains brain aneurysms.

Click play to watch the video or read video transcript.

Signs That Emergency Treatment Is Needed

But if left untreated, a brain aneurysm may eventually rupture, bleeding into the brain and its surrounding membranes, causing a subarachnoid hemorrhage, which is a serious condition that can cause damage to the brain and be potentially life-threatening.

Warning signs of a ruptured aneurysm, Dr. Ching says, “are a very important sign to seek immediate, emergency medical attention,” to minimize brain injury and prevent death.

These signs include:

• A sudden, severe headache, “the worst headache in your life”
• Dilated pupils
• Numbness, weakness, or paralysis on one side of the body
• Stiff neck
• Nausea or vomiting
• Loss of consciousness
• Severe sensitivity to light
• Pain above or behind the eye
• Difficulty talking

Warning signs of a ruptured aneurysm, Dr. Ching says, “are a very important sign to seek immediate, emergency medical attention.”

Emergency Treatment

Emergency treatment of a ruptured aneurysm and hemorrhagic stroke begins with treating the blood pressure to reduce the bleeding risk, treating potential complications of the aneurysm rupture, and in many cases, relieving pressure on the brain by medical and surgical treatments, Dr. Ching says.

Then the aneurysm must be repaired to stop bleeding and/or the risk of rebleeding into the brain. This is performed through surgery or a minimally invasive alternative, endovascular coiling or coil embolization. 

Endovascular coiling is done without a head incision. Guided by a continuous x-ray image on a monitor, a neurointerventional specialist advances a catheter to the aneurysm, starting in a blood vessel in the groin. When the catheter reaches the aneurysm, the doctor introduces tiny platinum coils through the catheter into the aneurysm. The detachable coils conform to the shape of the aneurysm and close it off to stop bleeding and reduce the risk of bleeding to recur.

Dr. Bryan Ludwig talks about how aneurysms are treated.

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Risk Factors

A variety of factors raise the risk for developing brain aneurysms. But in some cases, people with no risk factors develop them, while others with risk factors don’t have aneurysms.

Aneurysm risk factors include high blood pressure, smoking cigarettes, family history of brain aneurysm, illicit drug use, binge drinking, head injury, being overweight, and other risk factors associated with vascular disorders such as atherosclerosis, or narrowing of the arteries. The risk rises after age 40.

Source: Esteban Cheng-Ching, MD, and Bryan Ludwig, MD, Clinical Neuroscience Institute; American Stroke Association; Brain Aneurysm Foundation; Bryan Ludwig, MD, Clinical Neuroscience Institute