Wilkins and Goldman raise a number of important questions in their letter. They should be cautioned though against rejecting the facts simply because their implications may represent an inconvenience. Unruptured aneurysms can and do present with both sudden and chronic headache—this may present a challenging clinical dilemma to the practitioner "at the frontline," but it is a fact nonetheless.In their correspondence, the authors choose to lump noncatastrophic recurring headache with cataclysmic or thunderclap headache. We did not. Aneurysms and, in particular, giant aneurysms, can act as expanding mass lesions that cause chronic headache. We identified seven patients who had presented with acute headache and aneurysms. Three patients had intracavernous aneurysms; acute pain from a confined but expansile cavernous lesion is well described and not surprising in view of the surrounding neuroanatomy.1 Three additional patients either had intramural thrombosis of the aneurysm or had a discrete, fibrous
Raps EC, Galetta SL, Rogers J, et al. Unruptured Aneurysms and Headache-Reply. Arch Neurol. 1994;51(5):448. doi:10.1001/archneur.1994.00540170019008
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