Narrative Review: Headaches After Reversible Cerebral Vasoconstriction Syndrome
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CHRONIC DAILY HEADACHE (SJ WANG, SECTION EDITOR)
Narrative Review: Headaches After Reversible Cerebral Vasoconstriction Syndrome Yu-Hsiang Ling 1,2 & Shih-Pin Chen 1,2,3,4,5 Accepted: 28 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Reversible cerebral vasoconstriction syndrome (RCVS) is a disorder with distinct features: recurrent thunderclap headaches with reversible vasoconstriction of intracranial arteries. Substantial studies regarding outcomes after RCVS were conducted, showing favorable functional outcomes in most patients despite the potentially life-threatening complications of RCVS, including ischemic stroke, intracranial hemorrhage, or convexity subarachnoid hemorrhage. However, patients may report headaches after the resolution of RCVS while relative studies were scarce. Recent Findings Two prospective studies from different cohorts consistently revealed that RCVS recurred in at least 5% of patients. Patients with prior migraine history and patients whose thunderclap headaches are elicited by sexual activity or exertion are at higher risk for RCVS recurrence. On the other hand, several retrospective studies and case reports reported that chronic headaches are common in RCVS patients after the resolution of acute bouts. The chronic headaches after RCVS are sometimes disabling in certain patients. Summary Headaches after RCVS are not uncommon but usually overseen. Medical attention and examinations are warranted in patient with RCVS who reported recurrence of thunderclap headaches or chronic headaches after RCVS. Keywords Chronic headache . Persistent headache . Recurrence . Reversible cerebral vasoconstriction syndrome . Thunderclap headache
Introduction RCVS is a syndrome characterized by recurrent thunderclap headaches that clustering within 2 to 3 weeks, accompanying with vasospasm of intracranial arteries revealed by This article is part of the Topical Collection on Chronic Daily Headache * Shih-Pin Chen [email protected] 1
Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
2
Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
3
Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
4
Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
5
Brain Research Center, National Yang-Ming University, Taipei, Taiwan
neuroimaging techniques, including computed tomography (CT) or magnetic resonance (MR) angiography, or transcranial Doppler scan. Demonstrating the reversibility of cerebral vasoconstriction is essential for diagnosis, which usually occurs within 3 months after the onset of RCVS [1–4]. In most patients, certain triggers, including defecation, exertion, bathing, coughing, and sexual activity, may elicit their thunderclap headaches during the acute phase of RCVS. Also, some patients with RCVS had identifiable secondary etiologies for RCVS, including postpar
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