What types of headaches occur with reversible cerebral artery vasoconstriction (RCVS)
About 60% of patients develop the syndrome either postpartum or after exposure to vasoactive drugs (cannabis, ecstasy, selective serotonin reuptake inhibitors, triptans, cocaine, amphetamine, intravenous immunoglobulin).
This type of headache occurs more commonly in women (3:1) and typically presents between the ages of 20 and 50 years (range 10 to 76 years).
Multiple thunderclap can be associated with nausea and/or vomiting. Photophobia is a presenting feature in 94% of cases.
Multiple thunderclap headaches may occur over a mean period of 1 week and may occur spontaneously or be triggered by cough, exertion, or Valsalva. One of the defining features of RCVS is transient cerebral vasoconstriction, which resolves within 1 to 3 months.
Rare patients may develop NDPH.
Complications of RCVS include
- cervical artery dissection (12%),
- ischemic or hemorrhagic stroke (6% to 30%),
- cortical subarachnoid hemorrhage (22% to 34%),
- posterior reversible encephalopathy syndrome (9%),
- seizures (3% to 9%).
Nimodipine, nifedipine, and verapamil have been used. However, there are no placebo-controlled trials.
