Headache is among the most frequent symptoms to seek medical care. Careful evaluation by history-taking and appropriate physical examination is needed to exclude the potential secondary causes of headaches. In the elderly population, secondary headaches are more prevalent compared with the younger adult population. We present the case of a 70-year-old man who presented with a three-month history of headache with visual disturbances. He reported that this was the first time he experienced such a headache. The patient had a longstanding history of hypertension, diabetes mellitus, dyslipidemia, and ischemic heart disease. He was a heavy smoker with a 35 pack-years smoking history. In view of the clinical signs and symptoms, the patient underwent a computed tomography scan that revealed a right internal carotid artery aneurysm. For better evaluation, magnetic resonance imaging of the brain was performed and re-demonstrated the saccular aneurysm of the terminal part of the right internal carotid artery aneurysm, measuring 48 x 37 x 31 mm and partially thrombosed with a surrounding mural hematoma. The neck of the aneurysm measured 4 mm. The decision for surgical management was planned. The patient underwent craniotomy with surgical clipping of the aneurysm. No complications occurred during the operation. The patient had an uneventful recovery. Elderly patients with chronic headaches should be carefully evaluated for secondary headaches. A giant cerebral artery aneurysm is an uncommon etiology of secondary headache that needs prompt diagnosis and management.

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