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Recumbent thunderclap headache in the postpartum period
Stacy M Lenger1, Breton F Barrier
1Department of Obstetrics, Gynecology, and Women's Health, University of Missouri School of Medicine, Columbia, Missouri.
Obstetrics and Gynecology
|January 14, 2014
Summary
Thunderclap headaches in the postpartum period may signal reversible cerebral vasoconstriction syndrome (RCVS). Prompt treatment with calcium channel blockers can rapidly resolve symptoms and prevent serious neurological injury.
Area of Science:
- Neurology
- Vascular Neurology
Background:
- Reversible cerebral vasoconstriction syndrome (RCVS) presents with thunderclap headaches and reversible vasoconstriction.
- It may occur with or without other neurological symptoms.
Observation:
- A postpartum woman experienced recurrent thunderclap headaches, particularly when lying down.
- Cerebral angiography revealed segmental cerebral artery vasoconstriction.
Findings:
- The patient was diagnosed with RCVS based on clinical presentation and angiographic findings, with vasculitis excluded by cerebrospinal fluid analysis.
- Treatment with a calcium channel antagonist led to rapid symptom resolution.
Implications:
- Thunderclap headaches during the postpartum period, especially when triggered by Valsalva or recumbency, warrant consideration of RCVS.
- Untreated RCVS poses a risk of significant neurological damage.
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