6.3 Headache attributed to unruptured vascular malformation

Identification: Female patient, 35 years old, previously healthy.

Clinical History: The patient presents to the emergency department with a complaint of intense and sudden headache, described as "the worst headache of her life," with onset 2 hours ago. She reports that the pain is diffuse, pulsatile, with an intensity of 9/10, associated with nausea and photophobia. She denies any previous history of similar headaches or recent head trauma. She mentions the use of a nasal decongestant containing pseudoephedrine in the last 48 hours.

Physical Examination: On neurological examination, the patient was alert, oriented, without motor or sensory deficits. Fundoscopy showed no papilledema. Blood pressure: 130/85 mmHg. The remainder of the physical examination was unremarkable.

Complementary Exams: Initial non-contrast cranial computed tomography (CT) was normal. Magnetic resonance angiography (MRA) revealed multiple areas of segmental narrowing of the cerebral arteries, consistent with vasoconstriction.