6.3.1 Headache attributed to unruptured saccular aneurysm

Identification: Female patient, 45 years old, with no known comorbidities, positive family history for cerebral aneurysm (mother with subarachnoid hemorrhage at 50 years old). History of Present Illness: Intermittent headache for 3 months, unilateral on the right side (frontotemporal region), described as pulsatile (intensity 5-6/10). Characteristics: Duration: 1 to 4 hours, without aura. No nausea, vomiting, photophobia, or phonophobia (does not meet criteria for migraine). Progressive worsening in the last 15 days, with more frequent episodes. No associated neurological deficit. No history of trauma or recent infections. Neurological Examination: Normal (NIHSS = 0, no meningeal or focal signs). Fundoscopy: No papilledema or hemorrhages. BP: 125/80 mmHg. Complementary Exams: Brain Magnetic Resonance Imaging (MRI): Unruptured saccular aneurysm (5 mm) at the bifurcation of the right middle cerebral artery. No signs of bleeding or parenchymal compression. MR Angiography: Confirms aneurysm without vasospasm or intraluminal thrombosis. CSF (lumbar puncture, if performed): No xanthochromia or red blood cells (excludes occult subarachnoid hemorrhage).