Should you screen for an aneurysm in a migraineur whose mother died from a ruptured intracranial saccular aneurysm?

CLINICAL HISTORY A 32-year-old woman with migraine without aura, occurring on average two times per month since she was a teenager, was concerned about her risk of an aneurysm and requested evaluation. Her mother died at aged 58 years from a ruptured intracranial saccular aneurysm; there was no other relevant family history. I ordered an MRI scan of the brain with intracranial magnetic resonance angiography (MRA), but the HMO medical director would not authorize the study because he believed it was not indicated, citing a recent study published in the New England Journal of Medicine. 1