Continuous Hemicrania After Clipping of Internal Carotid Aneurism: Case Report

Context: The trigeminal autonomic cephalalgias (TACs) are primary headaches, however there are some reports of patients with TAC phenotypes related to vascular or neoplastic lesions. We discuss here the case of a patient presenting a headache with a pattern of continuous hemicrania developed after aneurysm clipping surgery. Case report: Male, 37 years old, presented with periodic migraine since childhood, worsening after surgical approach of a ruptured right internal carotid artery aneurysm in 2014. Developed structural epilepsy after the surgical approach. Headache begins in the right occipital region radiating to right hemicranium, of severe intensity, pulsatile, intermittent, lasting 2 hours, partial improvement between crises, with persistence of mild to moderate pain between crises. Exacerbations were accompanied by ocular hyperemia and ipsilateral lacrimation, little improvement with analgesics. Normal neurological examination. Presented total control of the pain after the introduction of indomethacin. Conclusion: Continuous hemicrania is a primary headache with a therapeutic response to indomethacin, classified in the TACs group. Secondary cases may be related to trauma, craniotomy, expansive intracranial injury, among others. The patient presented with these headaches after a surgical approach to clip a ruptured aneurysm. Previous headaches had another pattern. There is a previous report of continuous hemicrania related to an aneurysm of the anterior communicant. This extremely rare case illustrates the importance of testing with indomethacin when this phenotype is present, even in the presence of a triggering factor.