unilateral head pains, concerned about aneurysm.

[backhome22]

I am 21/female/general good health. For the past few months, I have been suffering from head pains. They are unilateral, confined to the temporal area/behind the eye. The pains varies from sharp jerks that last a few seconds, to painful pressure in a very small area, as if someone if pushing the blunt end of a pen into my temple. It mostly comes from the area right over my superficial temporal artery, which is puffy and raised often. There is also pain behind my eye that occasionally lasts for hours. Sometimes the sharp jolts of pain make me dizzy. Sometimes a strange "ticking" or "popping" sound is heard inside my head, seeming to come from my temple area. They do not respond to any medications.

I had a CT and an MRI W/Conrast. Both were unremarkable. I am having serious psychological problems due to thinking it may be an unruptured aneurysm. Everything I can find on the internet indicates that only an MRA can detect and unruptured aneurysm.

My question is, was the MRI w/contrast enough to rule out a cerebral aneurysm? I am very worried as I don't know what else it could be.

[Dr. Joshua]

Hi, please also see a related previous Q&A:
http://askdoctorjoshua.com/2007/01/23/eye-symptoms-a-sign-of-brain-aneurysm/

To summarize, it's rare for such symptoms as yours to be caused by an unruptured brain aneurysm.

I cannot say what is causing your symptoms, and I won't speculate on what examinations should be done when such symptoms are present, but to answer your specific question regarding radiological investigations and brain aneurysms:

Depending on the local protocol, MRA, CT angiography (CTA), or digital subtraction angiography (DSA) are used to rule out cerebral aneurysms.

The sensitivity of these examinations vary from one center to another, depending on the technology and software used - DSA is the golden standard, but it comes with higher risks.

We use almost exclusively CTA with 3D reconstruction and interpretation by a neuroradiologist. If we don't see an aneurysm there, we consider it ruled out. Some centers have very good MRA systems, probably approaching similar sensitivity.