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Reversible cerebral vasoconstriction with thunderclap headache: A case report
Jae Young Ji1, Ho Soon Jung, Sie Hyeon Yoo
1Department of Anesthesiology and Pain Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Chungcheongnam-do, Republic of Korea.
Medicine
|December 6, 2019
Summary
Reversible cerebral vasoconstriction syndrome (RCVS) causes severe headaches, often mistaken for migraines. Trigger point injections in temporal muscles effectively reduced headache severity in a patient unresponsive to conventional treatments.
Area of Science:
- Neurology
- Vascular Neurology
- Headache Medicine
Background:
- Reversible cerebral vasoconstriction syndrome (RCVS) presents with thunderclap headaches and can lead to severe complications.
- RCVS is challenging to distinguish from other headache types based on clinical presentation and initial imaging.
- This case report details a patient with RCVS presenting with severe headache upon defecation.
Observation:
- A 42-year-old female experienced a severe throbbing headache (Numeric Rating Scale 10) post-defecation, with temporary relief from analgesics.
- Initial brain CT and MR angiography showed no specific findings; RCVS was diagnosed via CT angiography one month later.
- Pharmacological treatments including pregabalin, oxycodone HCl/naloxone, and frovatriptan were ineffective.
Findings:
- Bilateral trigger point injections (TPI) in the temporal muscles were administered over four sessions.
- Following TPI, the patient's headache severity decreased significantly from NRS 10 to 2.
- Medication provided no relief, highlighting the efficacy of TPI in this case.
Implications:
- RCVS diagnosis requires careful consideration due to its potential for fatal outcomes.
- Trigger point injections may offer a viable treatment option for RCVS-associated headaches refractory to medication.
- Comprehensive diagnostic and treatment strategies are crucial for managing RCVS and co-occurring headaches.
