An “Ice Cream Headache” in a Term Gravida: A Case Report

BACKGROUND: Headache is often the only presenting symptom of subarachnoid hemorrhage. Its incidence in pregnancy of 5 per 100,000 is dwarfed by more common, benign causes of headache, complicating diagnosis. CASE: We presented a 41 year old at 38 weeks 5 days gestational age that presented local hospital reporting a “terrible brain freeze” after eating ice cream. After transfer of care to a tertiary care center a non-contrast computed tomography scan revealed subarachnoid blood layering in the basal cistern suspicious for sequelae of aneurysm rupture. After a cesarean section was performed the patient was transported to the interventional radiology suite where rupture of a 3mm left paraopthalmic artery aneurysm was confirmed and coiled. A non-ruptured 4mm right paraopthalmic artery aneurysm was also diagnosed. The patient was moved to the Intensive Care Unit in stable condition following the procedures and was discharged post-op day 7. She returned one month later for coiling of the right paraopthalmic artery. CONCLUSION: Headaches during pregnancy can indicate a variety of disease processes. Subarachnoid hemorrhage has high morbidity and mortality for mother and fetus making prompt diagnosis and treatment crucial. This case highlights the safety and importance of prompt cranial imaging in pregnancy when clinically appropriate.