6.7.3.2 Acute headache probably attributed to reversible cerebral vasoconstriction syndrome (RCVS)

Identification: Sex/Age: Female, 38 years. Background: Migraine without aura, occasional use of triptans. Recent medication: Use of nasal decongestant (phenylephrine) for the past 3 days for sinusitis. Family history: Mother with migraine. History of Present Illness (HPI): Main symptom: Sudden and severe headache ("the worst of her life"), for 12 hours. Pain characteristics: Onset: Explosive, during sexual intercourse (exertional headache). Location: Bilateral, occipital. Character: Throbbing. Intensity: 10/10. Associated symptoms: Nausea and vomiting. Transient photophobia and phonophobia. No focal neurological deficit. Physical/Neurological Examination: General: Consciousness preserved, in distress due to pain. Neurological: No papilledema. No meningeal signs. Normal motor/sensory examination. Complementary Examinations: Non-contrast cranial CT: No hemorrhage or structural lesion. Cerebral MR angiography: Multifocal segmental narrowings ("string of beads") in anterior and middle cerebral arteries. CSF (lumbar puncture): No pleocytosis or blood (excluding SAH).