Patients with reversible cerebral vasoconstriction syndrome may have long-term headaches

Only a history of prior headaches was linked to its incidence in roughly 50% of reversible cerebral vasoconstriction syndrome (RCVS) patients who experienced long-term headaches (LTH), says an article published in the Journal of Neurology. 

The diagnosis of reversible cerebral vasoconstriction syndrome depends on the patient's clinical presentation because angiographic vasoconstriction is frequently not visible when symptoms first appear. The prevalence and predictors of long-term headaches are poorly understood, despite the fact that thunderclap headache is a distinguishing characteristic of RCVS. Neha Kumar and team conducted this study with two objectives to characterize the occurrence and determinants of LTH beyond the acute phase of RCVS and to assess the sensitivity and specificity of a recently created score (RCVS2) for vasoconstriction identification in a real-world clinical situation.

retrospective review of all patients who received an RCVS clinical diagnosis at a tertiary institution between 2017 and 2021 LTH (defined as at least one episode present at more than 6-months follow-up requiring medication) was evaluated in relation to demographic parameters, medicines, comorbidities, imaging features, and demographic factors. Based on predetermined cutoffs (certain 5, negative 2), the connection between the RCVS2 score and angiographic vasoconstriction was separately studied. Its sensitivity, specificity, and negative and positive predictive values were then calculated.

The key findings of this study were:

55 patients, aged 50.5 ( 13.7) years; 75% of them were female. 

Only a past history of headaches was substantially related with LTH in 25 (49%) of the individuals who developed LTH. 

The RCVS2 score and angiographic vasoconstriction were shown to be significantly correlated; the sensitivity, specificity, positive and negative predictive values were 64%, 94%, 95%, and 58%, respectively.

In conclusion, regardless of the time of imaging, this study demonstrated a significant correlation between the RCVS2 score and the existence of radiographic vasoconstriction, indicating that the score may be a helpful diagnostic auxiliary tool. These results require external validation in more substantial, prospective, multicenter cohorts.

Reference: 

Kumar, N., Kumar, S., Rocha, E., & Lioutas, V.-A. (2022). Vasoconstriction and long-term headache in reversible cerebral vasoconstriction syndrome. In Journal of Neurology. Springer Science and Business Media LLC. https://doi.org/10.1007/s00415-022-11511-2