When a Headache Can Be Deadly: What to Know About Brain Aneurysms

While headaches are common and usually harmless, a crippling headache that comes on suddenly can signal a life-threatening condition—a ruptured aneurysm—that requires immediate medical attention, say experts with Baptist Health Brain & Spine Care in Miami and Boca Raton.

“A sudden, severe headache—often described as ‘the worst headache of someone’s life’—necessitates immediate medical evaluation, as it could indicate a life-threatening rupture,” says Guilherme Dabus, M.D., co-director of interventional neuroradiology at Baptist Health Miami Neuroscience Institute.

What Exactly Is a Brain Aneurysm?

A brain aneurysm is a weakness in the wall of a cerebral artery that causes a bulge or ballooning effect. Most aneurysms may be completely “silent” and asymptomatic until they rupture and bleed, abruptly causing what Dr. Dabus says is “a headache unlike anything you’ve ever experienced.”

According to the Brain Aneurysm Foundation, more than 6 million people in the United States—1 in 50—have unruptured brain aneurysms. However, not all aneurysms require intervention as most don’t ever rupture. Many more people likely have brain aneurysms and will go through their entire lives without even knowing it.

When a Brain Aneurysm Ruptures

Roughly 30,000 people a year do suffer a rupture, however, which can cause a hemorrhagic stroke, severe complications and even death. “A ruptured aneurysm may have catastrophic consequences in roughly two-thirds of those cases,” says Dr. Dabus. “Fifteen percent of those patients will die before they even reach the hospital. About 25% percent will die within 24 hours and another 25% will experience complications including death within 6 months.” 

 Those who survive a ruptured brain aneurysm may experience ongoing challenges, Dr. Dabus notes. “That’s why early detection and appropriate medical management are so important. With advances in imaging and treatment and access to experienced multidisciplinary teams, prognoses have improved dramatically for ruptured aneurysms.”

Warning Signs of a Brain Aneurysm

Symptoms of a brain aneurysm depend on whether the aneurysm is unruptured or ruptured, according to Brian Snelling, M.D., director of cerebrovascular and endovascular neurosurgery at Marcus Neuroscience Institute, part of Baptist Health, at Boca Raton Regional Hospital.

“Brain aneurysms are often detected during imaging studies for unrelated symptoms,” Dr. Snelling notes. “Many people learn that they have a brain aneurysm incidentally when they seek treatment for a different condition such as headaches, dizziness or sinus problems and the bulge is detected during diagnostics like MRIs or CT scans.”

While the hallmark symptom of a ruptured brain aneurysm is a sudden, intense headache, says Dr. Snelling, there may be other symptoms, too. Additional signs may include:

·      Nausea and vomiting

·      Blurred or double vision

·      Sensitivity to light

·      Seizures

·      Loss of consciousness

·      Neck pain or stiffness

·      Sudden confusion or difficulty speaking

How Ruptured Aneurysms Are Treated

Dr. Dabus says the primary goal in treating a ruptured brain aneurysm is to “secure the vessel as soon as possible—optimally within the first 24 hours—to reduce the risk of further bleeding.”

When a patient is diagnosed with a rupture, physicians follow a three-step treatment protocol:

·      Immediate Stabilization: If pressure within the skull increases (hydrocephalus) as a result of bleeding, a catheter may be used to relieve it.

·      Securing the Aneurysm: Whether by endovascular coiling or surgical clipping, most ruptured aneurysms are treated within 24 hours of hospital admission.

·      Multidisciplinary Care: Recovery from a ruptured aneurysm often involves neurocritical care and months of rehabilitation.

Unruptured Aneurysms: Often Silent, Sometimes Symptomatic

While most unruptured aneurysms go unnoticed, Dr. Snelling says that some—depending on their size and location—may cause symptoms that can include:

·      Pain above or around an eye

·      Numbness, weakness or paralysis on one side of the face

·      Difficulty speaking or understanding language

·      Visual disturbances such as double vision or vision loss

·      Headaches

·      Difficulty with memory or concentration

Treatment Options for Unruptured Brain Aneurysms

Care strategies for brain aneurysms are increasingly personalized, says Dr. Snelling, with treatment decisions based on factors such as the aneurysm’s size, shape, and location; the patient’s age and health; and the likelihood of rupture.

Treatment options for unruptured brain aneurysms include:

·      Observation: When an aneurysm is small and shows low risk for rupture, regular monitoring with imaging may be recommended.

·      Endovascular Procedures: Minimally invasive options have advanced dramatically, according to Dr. Snelling, who is an expert in catheter-based approaches. Options include:

o   Coiling: Inserting platinum coils into the aneurysm via a catheter to promote clotting and minimize rupture risk.

o   Stent-Assisted Coiling and Flow Diverters: Placing mesh stents or flow-diverting devices in the parent artery to divert blood from the aneurysm and encourage healing.

o   Balloon Remodeling: Temporary balloon support may assist in coiling complex aneurysms. 

o   Surgical Clipping: Placing a titanium clip across aneurysm to block flow into aneurysm.

Many aneurysms previously deemed untreatable can now be addressed as a result of these innovations, says Dr. Snelling, who adds that advances in performing these procedures via the radial artery in the wrist improves safety and recovery for patients. “Advances in less invasive endovascular procedures have significantly improved survivability and reduced complications,” he says.

Another treatment, endovascular embolization, involves accessing the aneurysm without “open surgery” by threading a small plastic tube called a catheter through an artery, usually starting at the wrist or groin. Upon reaching the aneurysm, a wide variety of devices and techniques can be used to prevent blood from flowing into the aneurysm.

A more invasive procedure, suitable for select cases, is microsurgical clipping, in which the neurosurgeon places a clip on the neck of the aneurysm via a small opening in the skull. “We tailor the treatment plan to each patient’s unique situation,” Dr. Snelling says.

Are You at Risk for a Brain Aneurysm?

According to Dr. Dabus, several risk factors increase the likelihood of developing a brain aneurysm:

·      Age and Gender: Risk increases between ages 35 and 60; women are at slightly higher risk.

·      Family History: Having affected relatives and family members with a brain aneurysm can increase risk of developing one.

·      High Blood Pressure: Chronic hypertension weakens vessel walls.

·      Smoking: A significant modifiable risk factor for both formation and rupture.

·      Medical Conditions: Diseases like polycystic kidney disease, Marfan syndrome, Ehlers-Danlos syndrome, and fibromuscular dysplasia raise risk.

·      Trauma or Infection: Although uncommon, head injuries or certain infections may contribute.

·      Other: Heavy alcohol use and drug abuse (especially cocaine) are also risk factors.

Dr. Dabus advises that understanding these risks—especially your family history—can inform screening and prevention strategies.

If You Suffer a Ruptured Brain Aneurysm

In case of a ruptured brain aneurysm, prompt treatment is essential to prevent rebleeding, brain damage or death, Dr. Dabus emphasizes. If you or someone you know experiences the sudden, excruciating headache characteristic of a ruptured aneurysm, take these steps immediately:

1.     Call 911: “Time is brain,” says Dr. Dabus. “Do not delay.”

2.     Note Symptom Onset: Record when symptoms began to inform emergency responders.

3.     Request Specialized Care: For the best outcomes, Dr. Dabus recommends seeking care at facilities with expertise in interventional neuroradiology and neurosurgery. Miami Neuroscience Institute and Marcus Neuroscience Institute are known for their multidisciplinary approach, combining the expertise of neurosurgeons, interventional neuroradiologists, neurointensivists and other specialists to provide comprehensive care.

Both Dr. Dabus and Dr. Snelling stress the importance of multi-disciplinary teams and state-of-the-art technology in improving patient outcomes.

“Advancements in medical technology, surgical techniques, ICU and post-operative care have led to improved outcomes and increased survivability for patients with brain aneurysms,” says Dr. Dabus. “Additionally, ongoing research may lead to further breakthroughs in the future.”

September is National Brain Aneurysm Awareness Month. Click here for more information about brain aneurysms and the treatments available from Baptist Health Brain & Spine Care.

Guilherme Dabus, M.D., co-director of interventional neuroradiology at Baptist Health Miami Neuroscience Institute

Brian Snelling, M.D., director of cerebrovascular and endovascular neurosurgery at Marcus Neuroscience Institute, part of Baptist Health Brain & Spine Care