Reversible Cerebral Vasoconstriction Syndrome Triggered by Contact With Water in a Swimmer

Reversible cerebral vasoconstriction syndrome (RCVS) is a disorder characterized by segmental vasoconstriction of cerebral arteries, which leads to thunderclap-type headaches. These headaches peak in intensity within one minute and are often brought on by common triggers, such as contact with water, Valsalva maneuver, physical exertion, sexual activity, and use of vasoactive drugs, among others.

A 40-year-old woman presented with a history of several episodes of severe headaches precipitated by swimming at work. After an inconclusive computed tomography, magnetic resonance imaging, and magnetic resonance angiography of the brain, transcranial Doppler revealed constriction of the left middle cerebral artery. Treatment with verapamil led to resolution of symptoms after 2 months.

RCVS is likely underdiagnosed and carries with it a small risk for potentially fatal complications. Differentiating RCVS headaches from migraines, as well as other headache disorders, is essential, and the present case provides an opportunity to further clarify the delineation between them.