Reversible cerebral vasoconstriction syndrome (RCVS) is the second most common cause of thunderclap headache after aneurysmal subarachnoid hemorrhage (SAH) and the most common cause of recurrent thunderclap headaches.
Up to 40% of patients with RCVS have a history of migraine.
It is associated with selective serotonin reuptake inhibitors (SSRIs), triptans, cocaine, marijuana, tacrolimus, oral contraceptives, as well as the peripartum period.
Symptoms are often triggered by emotional stress, sexual activity, showering, straining, and physical exertion.
Although the vasoconstriction is reversible, it can cause intracranial hemorrhage, seizures, stroke, and coma.
Diagnosis is by history, cerebral angiography and exclusion of aneurysmal SAH.
Bottom Line: Consider RCVS in the differential of thunderclap headache and in patients who present with worse than usual migraine headache.
References
Arrigan MT, Heran MKS, Shewchuk JR. Reversible cerebral vasoconstriction syndrome: an important and common cause of thunderclap and recurrent headaches. Clin Radiol. 2017 Dec 21 [Epub ahead of print]
