Headaches and Aneurysms: Don't Brush Off Sudden or Severe Symptoms

New or severe headaches that start for no apparent or known reason likely require a medical evaluation. A sudden headache – so sharp that it’s nothing like you’ve ever experienced – is very likely a medical emergency.

A brain aneurysm can be the cause of such a once-in-a-lifetime headache. In 1988, when President Joe Biden was 45 years-old, he experienced such a jolting headache. He was rushed into surgery for a bleeding aneurysm. Actor Emilia Clarke of “Game of Thrones” had a similar experience in the beginning of 2011, shortly after filming the first season of the series.

There is no doubt that a brain aneurysm — a weak spot on an artery that balloons or bulges out and fills with blood — can be life-threatening. A ruptured brain aneurysm can cause bleeding in and around the brain, resulting in brain damage, coma, and even death. 

Robert Wicks, M.D., neurosurgeon, co-director of cerebrovascular surgery and director of the Neurosurgical Anatomy Laboratory at Baptist Health Miami Neuroscience Institute.

When an aneurysm ruptures, one always experiences a sudden and extremely severe headache, and may also develop: double vision, nausea, vomiting, stiff neck, sensitivity to light, seizures, loss of consciousness (brief or prolonged), and even cardiac arrest.

Most cerebral aneurysms do not show symptoms until they either become very large or rupture. Small, unchanging aneurysms generally will not produce symptoms, explains Robert Wicks, M.D., neurosurgeon, co-director of cerebrovascular surgery and director of the Neurosurgical Anatomy Laboratory at Baptist Health Miami Neuroscience Institute. Up to 2 percent of the population, meaning one in every 50 people, is estimated to have an aneurysm, but the vast majority do not rupture.

“Many times, patients are not aware of them,” said Dr. Wicks. “Occasionally, you will have some people who have an aneurysm that's located in a particular part of the brain that may affect their vision or cause them to have double vision. Rarely does an aneurysm cause persistent headaches.”

Dr. Wicks urges anyone who suddenly starts getting headaches – without having a history of headaches – to see a doctor who will likely recommend imaging studies. But in most cases, aneurysms are asymptomatic, he adds.

Family History, Smoking and Other Risk Factors

Sometimes cerebral aneurysms are the result of inherited risk factors. Other risk factors develop over time and include: untreated high blood pressure, cigarette smoking, and drug abuse, which can raise blood pressure to dangerous levels.

“One key risk factor is a family history of aneurysms,” explains Dr. Wicks. “If a person has at least two family members that have had an aneurysm or a ruptured aneurysm, we oftentimes will recommend -- starting at age 40 or 50 -- to get a special MRI of the brain called an MRA (magnetic resonance angiography). That looks at the blood vessels of the brain.”

If an aneurysm is diagnosed, Dr. Wicks considers different factors. Not every aneurysm goes on to rupture. Many people have an “incidentally identified aneurysm” which is found when assessing seemingly unrelated conditions or symptoms.

“We look at different factors,” said Dr. Wicks. “We look at the aneurysm size and the shape of the aneurysm Does it have irregularity or bumps on it? We also look at a patient's risk factors, such as smoking. Smoking's been shown to promote the development of aneurysms. But people who have them and continue to smoke are more likely to cause the aneurysm to change or grow.

“The other factor is looking at blood pressure and If somebody has uncontrolled high blood pressure. And all of that gets factored in. That's why it's really important to go to a center where a medical team is experienced in treating aneurysms. We’re able to go over the next imaging studies, and then recommend treatment options.”

Evaluating and treating Aneurysms

The team of specialists at Baptist Health Miami Neuroscience Institute uses the most sophisticated, leading-edge diagnostic imaging tools to determine the type of aneurysm, and pinpoint its exact location.

“A diagnostic catheter angiogram evaluates the aneurysm so we can look at its precise size and shape, and determine the best treatment options,” explains Dr. Wicks. “It's very similar to catheter angiograms of the heart. Basically, we place a small catheter either in the radial artery in the wrist or in the femoral artery in the leg. Under X-ray guidance, we can navigate that small catheter through the blood vessels up to the neck. And we can inject contrast dye that allows us to look at the arteries under high detail and also get 3D images of the aneurysm.”

The majority of aneurysms can now be treated endovascularly, referring to a minimally invasive surgical procedure.

Endovascular coiling, or coil embolization, is the most common minimally invasive method for treating cerebral aneurysms. The surgeon uses fluoroscopy (live X-ray) to thread a catheter from a blood vessel in the groin to the blood vessels in the brain, ending at the aneurysm’s exact location. They push tiny platinum coils into the aneurysm. The coils take on the shape of the aneurysm to clot it off (embolization) and stop blood flow, preventing rupture.

In some cases, clipping is the alternative to the minimally invasive procedure. Clipping is an open surgical procedure to seal off the aneurysm and prevent blood from entering. Clipping of brain aneurysms has been available longer than endovascular therapy, and has excellent long-term results. In recent years, titanium clips and smaller surgical approaches have been used for sealing.

“There are particular aneurysms that do have a particular shape to them, or they're located in a particular area, and we do still consider clipping as a treatment,” said Dr. Wicks. “And we have developed a little bit less-invasive surgeries for the aneurysms when that is required, such as smaller skin incisions. And that's still a very effective treatment that we can offer at Miami Neuroscience Institute.”