Post-reversible cerebral vasoconstriction syndrome headache

Abstract

Background Chronic headache may persist after the remission of reversible cerebral vasoconstriction syndrome (RCVS) in some patients. We aimed to investigate the prevalence, characteristics, risk factors, and the impact of post-RCVS headache. Methods We prospectively recruited patients with RCVS and collected their baseline demographics, including psychological distress measured by Hospital Anxiety and Depression scale. We evaluated whether the patients developed post-RCVS headache 3 months after RCVS onset. The manifestations of post-RCVS headache and headache-related disability measured by Migraine Disability Assessment (MIDAS) scores were recorded. Results From 2017 to 2019, 134 patients with RCVS were recruited, of whom, 123 finished follow-up interviews (response rate 91.8%). Sixty (48.8%) patients had post-RCVS headache. Migrainous features were common in post-RCVS headache. Post-RCVS headache caused moderate-to-severe headache-related disability (MIDAS score > 10) in seven (11.7%) patients. Higher anxiety level (odds ratio 1.21, p = 0.009) and a history of migraine (odds ratio 2.59, p = 0.049) are associated with post-RCVS headache. Survival analysis estimated that 50% post-RCVS headache would recover in 389 days (95% confidence interval: 198.5–579) after disease onset. Conclusions Post-RCVS headache is common, affecting half of patients and being disabling in one-tenth. Higher anxiety level and migraine history are risk factors. Half of the patients with post-RCVS headache would recover in about a year.

Cerebral perfusion variance in new daily persistent headache and chronic migraine: an arterial spin-labeled MR imaging study

“…Regarding NDPH, reduced cortical cerebral perfusion may be associated with compensatory vasoconstriction due to persistent headache. A previous study reported two cases of NDPH-like headaches after acute bouts of reversible cerebral vasoconstriction syndrome (RCVS), which suggested that vasoconstriction in RCVS may be regarded as a trigger for NDPH-like headache [48]. In addition, the persistence of headache attacks might accelerate the decreased cerebral perfusion in NDPH.…”

Reversible cerebral vasoconstriction syndrome after levonorgestrel‐releasing intrauterine device placement—Case report

“…RCVS typically has a benign course and symptoms usually resolve in days to weeks. Although most patients have a favorable outcome, it should be emphasized that RCVS remains a medical emergency due to its potentially devastating complications including intracranial hemorrhage, ischemic stroke, seizures, and posterior reversible encephalopathy 8,14,15 . The majority of RCVS cases have a clear precipitating factor or agent.…”

Update of New Daily Persistent Headache

“…Subsequent studies also reported several cases of NDPH with a typical thunderclap headache onset [ 34 , 35 ]. Two cases of NDPH-like headaches after the acute bouts of reversible cerebral vasoconstriction syndrome (RCVS) have been reported [ 36 ]. These cases suggest that either they belong to a subtype of NDPH, which shares a similar etiology with the RCVS-spectrum disorders; or vasoconstriction in RCVS may be regarded as a trigger for NDPH-like headache.…”