Hemicrania continua associated with an unruptured anterior communicating artery aneurysm: first case report

Aug 28, 2026

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A letter to the editor presents the first case report of hemicrania continua associated with an unruptured anterior communicating artery aneurysm. A 51-year-old woman experienced a 24-month continuous right-sided headache with cranial autonomic symptoms and intermittent sharp pains. The diagnosis was supported by prompt headache resolution with indomethacin at 50 mg three times daily. Imaging confirmed an 8×7×9 mm anterior communicating artery aneurysm, and endovascular treatment was unsuccessful, requiring continued indomethacin control.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

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Case presentation

Symptoms and medical history

Examination and imaging

Treatment and outcome

Discussion

Imam The Journal of Headache and Pain (2021) 22:11 [https://doi.org/10.1186/s10194-021-01219-5](https://doi.org/10.1186/s10194-021-01219-5) The Journal of Headache and Pain LETTER TO THE EDITOR Open Access Hemicrania continua associated with an unruptured anterior communicating artery aneurysm: first case report Ibrahim Imam The Editor. Journal of Headache and Pain. Dear Sir. I present this 51-year-old woman who presented with a 24-month history of a gradual onset right sided headache which was continuous from the start. It was predominantly over the parieto-occipital area, the forehead and cheek, and she also had occasional sharp shooting pains over the left side of her head and neck. She had right sided photophobia but did not have nausea. The headache was associated with watering of the right eye, and occasionally blockage of the right nostril. She had not noticed any reddening of the eye. She described the headaches as disabling. She has a history of hypertension and was on Ramipril; a temporary withdrawal did not resolve the headache. She has no relevant family history. She smokes 15 cigarettes a day but drinks alcohol only occasionally. She reported significant personal and family stress related to recent bereavement from the loss of her mother. On examination, her right conjunctiva was slightly red. Her cranial nerves and systemic neurological examination were otherwise normal. The clinical diagnosis of hemicrania continua was made and her headaches resolved promptly on Indomethacin but only at a dose of 50 mg three times a day. Her magnetic resonance imaging brainscan showed an 8 × 7 × 9 mm anterior communicating artery aneurysm which was confirmed with a subsequent computed tomography angiogram Correspondence: [ibrahimimam2000@yahoo.com](ibrahimimam2000@yahoo.com) Royal Devon and Exeter Hospital, Exeter, UK (Fig. 1) . Unfortunately, an attempt to treat the aneurysm interventionally was unsuccessful, and she remains on Indomethacin for control of her headache. Discussion This is the first case report of hemicrania continua in association with an anterior communicating artery aneurysm. The patient’s history and response to indomethacin are entirely consistent with hemicrania continua. Hemicrania continua predominantly affects females and it is typically a moderately severe unilateral continuous headache which may be associated with intermittent jabs and jolts as is the case with this patient [1, 2] . Hemicrania continua has been reported in association with a variety of intracranial pathologies especially traumatic brain injury, sinusitis, primary and secondary brain tumours, internal carotid artery dissection, dental, orbital and temporomandibular joint problems [3, 4] . Rarer secondary causes of hemicrania continua include carotid cavernous fistula and cerebral vein thrombosis (CVT) [5, 6] . There is however only one case report of hemicrania continua in relation to an intracranial aneurysm, and this was of the internal carotid artery [7] . Cerebral aneurysms on the other hand have been reported in association with other trigeminal autonomic cephalalgias such as cluster headaches and short-lasting unilateral neuralgiform headaches with conjunctival injection and tearing (SUNCT) [8, 9] . There is a possibility that the aneurysm in this case is coincidental, unruptured aneurysms being present in 2% of the general population [10] . In this case, it was difficult to be absolutely certain of the causative © The Author(s) . 2021 Open Access This article is licensed under a Creative Commons Attribution 4 . 0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commo

FAQs

What symptoms were reported in the presented hemicrania continua case?

The patient had a gradual-onset right-sided headache continuous from the start, mainly over the parieto-occipital area, forehead, and cheek, with occasional sharp pains on the left side of the head and neck. She also reported right photophobia, watering of the right eye, and occasional right nostril blockage.

How was hemicrania continua diagnosed and treated in this report?

A clinical diagnosis of hemicrania continua was made. The headaches resolved promptly on indomethacin at 50 mg three times a day.

What did imaging show and how did it affect management?

MRI and subsequent CT angiogram showed an 8×7×9 mm anterior communicating artery aneurysm. An attempt to treat the aneurysm interventionally was unsuccessful, so indomethacin was continued to control the headache.

Aug 28, 2026

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