- Idiopathic, medium-sized cerebral artery vasospasm
- Most commonly occurs in women in their 5th decade of life (40-50 years old)
- Pregnancy or Postpartum
- Medications
-
Thunderclap Headache
- Recurrent, sudden onset Headaches over a 1-3 week period
- Nausea or Vomiting
- Photophobia
- Confusion
- Blurred Vision
- Associated Neurologic Effects (may not be transient if significant Hemorrhage or ischemia)
- See Thunderclap Headache
- Pregnancy Induced Hypertension
-
Posterior Reversible Encephalopathy Syndrome (PRES)
- Slower onset of Headache (contrast with Thunderclap Headache in RCVS)
-
Lumbar Puncture
- Exclude Subarachnoid Hemorrhage (esp. if presentation >6 hours after onset of Thunderclap Headache)
-
CT Head
- Exclude Intracranial Hemorrhage (lower test sensivity after 6 hours of Thunderclap Headache)
- CT Angiogram (or MR Brain/MRA Brain and Neck)
- May be diagnostic for RCVS
- Discontinue causative factors (e.g. Sympathomimetics)
- Manage related conditions
- Headache prophylaxis
-
Headache abortive care
- Oral Magnesium may be effective
- Episodes decrease over time with treatment and with distance from precipitating factors
- However, minor Disability may persist in up to 29% of patients
- Pensa and Roth in Herbert (2020) EM:Rap 20(12): 4-5
- Sattar (2010) Expert Rev Cardiovasc Ther 8(10): 1417-21. [PubMed]