# Recurrent, Severe Coital Headaches Associated With Bilateral Carotid Artery Aneurysms and the Effect of Endovascular Treatment

## TL;DR

A 41-year-old woman with severe coital headaches was found to have carotid artery aneurysms, and her symptoms improved after endovascular treatment.

## Contribution

This case highlights a rare association between coital headaches and carotid artery aneurysms, emphasizing the importance of thorough differential diagnosis.

## Key findings

- Bilateral carotid artery aneurysms were identified as the cause of recurrent coital headaches in a patient with a history of migraines.
- Endovascular stent placement led to significant improvement in headache frequency and resumption of normal sexual activity.
- The case underscores the need to consider life-threatening causes when evaluating recurrent coital headaches.

## Abstract

Headaches are one of the most common chief complaints in the outpatient setting. Distinguishing between benign and life-threatening headaches can be difficult, particularly in the setting of a pre-existing history of headaches. Here, we present a 41-year-old female with a past medical history of migraines and uterine leiomyoma status post hysterectomy about nine months ago who presented to the clinic for severe coital headaches and worsening migraines starting eight months ago. Computer tomography angiogram (CTA) head and neck demonstrated bilateral para-ophthalmic internal carotid artery (ICA) aneurysms (right, 7.5, left 6 mm). A diagnostic cerebral angiogram (DSA) was subsequently done and confirmed the CTA findings. The patient underwent left and right flow-diverting stent placement two and four months later, respectively. One week after the right ICA stent placement, her headaches had improved to one to two times per week. At six months after the stent placement, she resumed her normal sex life and her migraines returned to baseline. Our case suggests that recurrent severe coital headaches are associated with bilateral carotid artery aneurysms. Thus, while assessing a patient with recurrent coital headaches, it is important to have a wide arsenal of differentials to rule out possibly catastrophic causes.