| Summary: | Subarachnoid hemorrhage (SAH) has a high mortality rate, and cerebral aneurysm
ruptures account for 80% of all cases. Although several previous case studies
have reported a headache before aneurysmal SAH, no previous study has reported a
case of SAH after a change in the existing migraine pattern without any other
clinical signs. A 43-year-old male patient who had suffered chronic migraines for
10 years visited the emergency department due to migraine symptoms, which
exacerbated 3 days before the visit. He was admitted for symptom management, and
his condition improved after taking migraine-specific medication. However, his
consciousness deteriorated, and he became drowsy 8 days from the onset of
headache aggravation. Brain computed tomography angiography revealed SAH. A small
ruptured aneurysm, which was not detected by brain magnetic resonance angiography
performed a few days earlier, was found in the A1 segment of the right anterior
cerebral artery. We performed emergency endovascular coil embolization in the
right A1 without any other complications. After the procedure, his neurological
symptoms no longer exacerbated during hospitalization. He showed only a mild
headache after 2 weeks and was discharged. Aneurysmal SAH is one of the most
devastating neurological diseases, but early detection and treatment of aneurysms
before major rupture may facilitate a good prognosis. If the pattern of
previously diagnosed chronic migraine changes suddenly, a minor leak before the
major rupture of a cerebral aneurysm should be considered, even if a sentinel
headache has not been suggested.
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