6.2.4.2 Persistent headache attributed to past non-traumatic subarachnoid haemorrhage

Identification: Female patient, 45 years old, with a history of aneurysmal subarachnoid hemorrhage (anterior communicating artery) treated with clipping 4 months ago, currently under neurological follow-up.

History of Present Illness:

Reports daily bilateral frontotemporal headache since the hemorrhagic event.

Characteristics:

Moderate intensity (5-6/10), with exacerbation episodes (8/10).
Pressure/throbbing quality.
Worsens with physical exertion and postural changes.
Partial relief with rest and dipyrone.

Associated symptoms:

Occasional postural dizziness.
Intolerance to noise (without classic phonophobia).
Denies: Nausea, vomiting, or recent focal neurological deficits.

Current Neurological Examination:

General state: GCS 15, conscious and oriented.
Meningeal signs: Absent.
Focal signs:
Mild cognitive deficit (MMSE 26/30) - impaired recent memory.
Brisk and symmetrical reflexes.
BP: 130/85 mmHg (normotensive).

Recent Complementary Exams:

Cranial CT (control):
Mild communicating hydrocephalus (Evans index 0.33).
Hemorrhage residues in basal cisterns.

Brain MRI:
Bilateral temporal gliosis post-SAH.
Excludes rebleeding or late ischemia.

MR Angiography:
Clipped aneurysm without recanalization.
Minimal residual vasospasm.