Is It A Headache-Or A Brain Aneurysm?

Is It A Headache-Or A Brain Aneurysm? A neurosurgeon explains when to be concerned and what action to take.

If you do have a severe and sudden onset headache, different in character or nature than any other headache that you’ve had, go to an emergency room for evaluation. Typically, examination takes the form of magnetic resonance angiography (MRA) or magnetic resonance imaging (MRI).

“The MRA is so easy to do,” Langer says. “It picks up about 97% of aneurysms that are bigger than 3 millimeters. And it’s a good test.”

But the doctor adds a note of caution about doing such tests without legitimate cause for concern, because a small finding could lead to a lifetime of undue worry.

“You can imagine where we’d be if we were doing MRAs on every patient with a headache,” he says. “So you have to be smart about this. Obviously, if it’s something that is really atypical, and you’re really stunned by it, then you deserve an MRA. If it’s the same old thing and it’s just the same or a little worse than normal, it’s probably a headache.”

Treatment for aneurysm

In the past, every aneurysm treatment involved craniotomy—that is, opening the skull. And because of the invasiveness of the approach, Langer says doctors “had to be more circumspect about treatment.”

Whereas now, he says catheter-based treatments exist for aneurysms. “They’re becoming more popular, though they’re not necessarily less risky,” he says. But they are less invasive. And that’s why the threshold to treat smaller aneurysms has been dropping.

“There’s an element of anxiety when living with an aneurysm, there’s a quality-of-life component,” he says. With less invasive, catheter-based treatments, some patients with smaller aneurysms at lower risk of rupture now more readily accept the risk of treatment as a reasonable tradeoff to eliminate worry.

The best time to treat an aneurysm is before it bleeds because the risk of death from a rupture in the brain is 50%. And, if a patient does bleed, the best time to treat is within 24 hours—“as soon as possible”—because the risk of re-rupture is high.

Can you prevent aneurysm?

Certain collagen vascular diseases, such as lupus and polycystic kidney disease, may be associated with aneurysm formation. So if you have one of those conditions, you may be at higher risk and should be checked more frequently.

A lifestyle of smoking, drinking, or using drugs in excess can contribute to the formation of aneurysms. And, Langer says, “there’s often not much you can really do to reverse whatever has caused these things.”

So overall, a generally healthier lifestyle can help prevent the formation of brain aneurysms—and contribute to better health outcomes across the board, too.