6.7.2 Angiography headache

A 45-year-old female patient, previously healthy, with no relevant history of chronic headache or other comorbidities.

Clinical History:
The patient underwent cerebral angiography due to suspected intracranial aneurysm following an episode of sudden and severe headache. The procedure was performed without apparent complications, using iodinated contrast. About 2 hours after the examination, the patient began to complain of intense, bifrontal, pulsatile headache, worsening when lying down and associated with nausea and photophobia. There were no signs of focal neurological deficit, fever, or neck stiffness.

Physical and Neurological Examination:

Blood pressure: 130/85 mmHg.

Heart rate: 78 bpm.

Neurological examination without abnormalities (level of consciousness preserved, pupils isocoric and reactive to light, no motor or sensory deficits).

Fundoscopy: no papilledema or other changes.

Complementary Examinations:

Non-contrast cranial CT: no signs of hemorrhage, edema, or expansive lesions.

Lumbar puncture: clear cerebrospinal fluid (CSF), normal opening pressure, proteins and glucose within normal parameters, no pleocytosis.