Fusiform aneurysms of the vertebral artery: a hidden cause of exertional headache?

Background: There is only one reported case of recurrent coital headache related to an unruptured saccular aneurysm of the carotid artery.

Methods: We report on two cases of isolated recurrent coital/exertional headaches ipsilateral to unruptured fusiform aneurysms of the vertebral artery diagnosed by CT angiography. While one case is being managed conservatively, a vertebral stent has been set in the other.

Conclusions: CT angiography with full visualisation of intracranial and upper cervical arteries could be used as a screening diagnostic procedure in these cases. Together with saccular aneurysms, fusiform aneurysms should be added to the IHS classification as aetiology for exertional recurrent headaches.