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Abstract: The patient, a 43-year-old male, reported that he started to have headaches when he was in college in his 20s, manifesting as swelling and pain on one side, accompanied by swelling and tearing of the eyes, and nausea and vomiting in severe cases, and was considered to be related to prolonged study stress at the time. Now that I am in my 40s, I still have recurrent headaches, and I came to the hospital for examination and considered migraine. The improvement of cranial magnetic resonance angiography revealed an internal carotid aneurysm, and medication + surgery was given, with good results and no special discomfort.
Basic information】Male, 43 years old
Type of disease】Migraine, internal carotid aneurysm
Hospital】Shandong Provincial Third Hospital
Consultation time】November 2019
Treatment plan】Medication (aminopyrine caffeine tablets, nimodipine tablets) + surgery (interventional embolization of intracranial aneurysm)
【Treatment period】13 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect】Good treatment effect, no special discomfort
I. Initial consultation
Recently, his wife asked him to come to the hospital for examination because he had been suffering from recurrent headache for more than 20 years, and recently his headache had become more severe due to stress at work, accompanied by hypertension, nausea and vomiting. The patient had no previous history of specific diseases and had a history of smoking. Early diagnosis of migraine was made, and it could be relieved after taking ibuprofen extended-release capsules and other pain-relieving drugs. Neurological examination did not show any significant positive signs, and the outpatient diagnosis of migraine was made. Considering that the patient had severe and recurrent headache, it was suggested to improve the intracranial vascular examination to assess the intracerebral situation and exclude intracerebral organic lesions.
II. Treatment history
The patient completed relevant laboratory tests in the outpatient clinic, including: blood routine, stool routine, urine routine, liver and kidney function, blood lipid, blood glucose, ion, cardiac enzyme, glycosylated hemoglobin, etc. Uric acid and blood lipid were found to be high. Complete cranial magnetic resonance and angiography suggested: internal carotid aneurysm, multiple ischemic foci in the brain. Cranial CT showed: no significant abnormalities on plain scan and paranasal sinusitis. Perfect EEG examination and foaming test did not show any significant abnormality, which could be diagnosed as intracarotid aneurysm.
For the patient’s condition, aminopyrine caffeine tablets and nimodipine tablets were given to relieve pain and release cerebrovascular spasm. On the 3rd day of medication, the headache symptoms were significantly relieved. Considering the patient’s large aneurysm and the risk of bleeding, interventional embolization of the aneurysm was suggested to be actively considered. The patient communicated with the patient in detail about his condition and the risks of surgery, and arranged for surgical treatment after a good preoperative evaluation.
(Cranial CT)
(Cranial magnetic resonance and angiography)
III. Treatment effect
Migraine is currently considered to be more likely to be caused by central nervous system disorder. Some patients have aura before the attack, such as distortion of vision, flashing light, and stimulation of sound and light will cause the headache to worsen. The patient was given aminopyrine caffeine tablets and nimodipine tablets to relieve cerebral vascular spasm and pain relief treatment, which was effective. However, during the examination, an aneurysm was found, and the risk of bleeding was later treated with interventional embolization of the aneurysm, and the patient was advised to go to the hospital for regular review and active monitoring of blood pressure. 1 month later, the patient had no special discomfort, blood pressure was controlled normally, and blood lipids and uric acid were controlled in the normal range.
IV. Notes
We are glad that the patient’s headache symptoms were relieved after treatment. After discharge, if headache attacks occur, attention should be paid to quiet bed rest, reducing physical exercise and avoiding emotional fluctuations. Diet should be light and nutritious, paying attention to low-salt and low-fat diet, which is helpful to avoid elevated blood pressure and blood lipids; avoid spicy, stimulating and greasy food. You should eat on time and in the right amount every day, and take your medication on time. In daily life, in order to prevent headache attacks, you should reduce brain work, avoid brain fatigue, increase exercise appropriately and enhance physical fitness. Pay attention to the severity of the headache and the blood pressure. If the headache worsens, or if the blood pressure is significantly elevated, you should go to the hospital for consultation. After the surgical treatment, patients should actively monitor blood pressure and go to the hospital after six months to review the joint head and neck CTA to assess the cerebrovascular condition.
V. Personal insight
Headache is a common clinical symptom that can be seen in a variety of diseases, and no further examination should be performed just because it has been diagnosed as migraine, as in the case of the patient in this case, where recurrent migraine turned out to be due to the presence of a carotid aneurysm. Therefore, if you have recurrent migraines and worsening headache symptoms, you should go to the hospital for detailed examination to investigate the possibility of other diseases. Good daily habits should be developed and attention should be paid to monitoring blood pressure, blood sugar, lipids and other high-risk factors to avoid the occurrence of diseases. Brain workers should pay attention to supplemental nutrition, improve physical fitness, enhance physical exercise and strengthen physical fitness is necessary.