Thunderclap headache and reversible segmental cerebral vasoconstriction associated with use of oxymetazoline nasal spray

Abstract

OXYMETAZOLINE IS A SYMPATHOMIMETIC amine found in over-thecounter nasal decongestants. We report a case of chronic use of nasal oxymetazoline associated with thunderclap headache due to reversible segmental intracranial vasoconstriction.

The diagnosis and management of rhinitis: An updated practice parameter

“…Intranasal decongestants usually do not cause systemic sympathomimetic symptoms; however, a variety of cerebrovascular adverse events have been reported, including anterior ischemic optic neuropathy, 920 stroke, 921 branch retinal artery occlusion, 922 and ''thunderclap'' vascular headache. 923,924 Caution for use of decongestants during the first trimester is recommended because fetal heart rate changes with administration during pregnancy 925 have been reported. Topical vasoconstrictors should be used with care below age 1 year because of the narrow margin between the therapeutic and toxic dose, which increases the risk for cardiovascular and CNS side effects.…”

Reversible Cerebral Vasoconstriction Syndrome Associated with Subarachnoid Hemorrhage

“…Neurological deficits range from mild to severe but usually improve as the vasculopathy resolves. While some cases are idiopathic [3], there appears to be an association with child birth [4], exertion [5], acute arterial hypertension [4,[6][7][8][9][10][11], and the administration of sympathomimetic [12], serotonergic [13][14][15], and dopaminergic drugs [16].…”

Reversible cerebral vasoconstriction syndrome presenting with haemorrhage

“…Another small series of RCVS in the post-partum context included one patient with a small subarachnoid overlying the right frontal cortex [15]. In sixteen individual case reports reviewed with RCVS, haemorrhage was found in four whilst ischaemic changes were found in twelve [4,5,16]. The four further cases we describe may help increase clinical vigilance regarding this condition, decreasing the likelihood of mis-diagnosing cerebral vasculitis and misusing aggressive and toxic immunosuppressive drugs.…”