Reversible Cerebral Vasoconstriction Syndrome

By | June 8, 2022

Reversible cerebral vasoconstriction syndrome is a condition associated with severe headaches. The intensity of this pain is so severe that it is sometimes referred to as a ‘ annihilation headache ‘. In some cases, reversible cerebral vasoconstriction syndrome is also referred to by the abbreviation RCVS or the synonymous term Call-Fleming syndrome. As part of the disease, the muscles in the cerebral vessels contract, resulting in severe headaches. Other neurological complaints do not occur in every case.

What is Reversible Cerebral Vasoconstriction Syndrome?

The reversible cerebral vasoconstriction syndrome is characterized by extremely severe headaches, so-called annihilation headaches . These may be accompanied by other neurological disorders. These include, for example, a stroke or seizure as well as a so-called subarachnoid hemorrhage. For about temporomandibular disorders, please visit

However, it is typical of the disease that the symptoms usually disappear again within a period of about three months. The disease has already been observed in people between the ages of 10 and 80. However, the typical symptoms occur most frequently in the 40th year of life.

It turns out that more female than male patients are affected by the syndrome. Precise information on the frequency of reversible cerebral vasoconstriction syndrome is not yet possible. However, the disease is not uncommon.

For example, it was found that the disease often occurs in women after childbirth or in the context of eclampsia. The syndrome also occurs frequently after the consumption of serotonergic and adrenergic substances or the intake of amphetamines and cocaine.


The causes of reversible cerebral vasoconstriction syndrome have not yet been conclusively researched. Basically, in most cases, the death headaches form in the back of the head and spread from there over the head.

Symptoms, Ailments & Signs

In the context of the reversible cerebral vasoconstriction syndrome, various symptoms and complaints occur in the affected patients. The central symptom is usually the headache. They often begin as a devastating headache. This pain starts suddenly and develops into extremely severe pain after a short time.

These headaches usually originate in the back of the head. However, the pain gradually spreads to cover the entire head. Other symptoms may be associated with this, such as confusional states, vomiting, nausea, a tendency to collapse, and sensitivity to noise and light.

These headaches resolve after a few minutes or days. On average, the pain in reversible cerebral vasoconstriction syndrome lasts for a few hours. Multiple attacks of annihilating headaches usually occur during the first few weeks.

In the meantime, the patients usually only suffer from mild headaches. Other complaints are also possible. These include, for example, deficits of a focal nature and epileptic seizures. It can also lead to dangerous complications, such as strokes.

Diagnosis & course of disease

The diagnosis of the reversible cerebral vasoconstriction syndrome can be made using various examination measures and methods. If people notice typical symptoms, they should see a doctor as soon as possible. In the first step of the diagnosis, he carries out an anamnesis with the patient.

During this conversation, he asks about the characteristic symptoms, lifestyle and consumption of stimulants, past illnesses and genetic dispositions. In this way, the specialist obtains important information in relation to the present disease. In the next step, the clinical symptoms of the affected patient are the focus of consideration.

If the person describes typical symptoms of the reversible cerebral vasoconstriction syndrome, a suspected diagnosis is already possible. Various studies are used to confirm this assumption. For example, the blood is examined for inflammatory markers and special antibodies. The urine is also analyzed.

Finally, imaging methods of the brain are used. In the course of these examinations, diffuse vasoconstrictions are found in many cases. Magnetic resonance imaging and computed tomography are also usually performed.

Infarcts caused by bleeding are sometimes visible here. Edema in the brain is also possible. With regard to the differential diagnosis, subarachnoid hemorrhage, torn cervical vessel walls and primary angiitis of the central nervous system must be ruled out in the first place.


Reversible cerebral vasoconstriction syndrome is a very serious condition, but it usually resolves on its own after about three months. However, the spasmodic narrowing of the cerebral vascular muscles can lead to strokes. These represent the most important complications of reversible cerebral vasoconstriction syndrome.

Both hemorrhagic and ischemic strokes occur. While a hemorrhagic stroke is characterized by cerebral hemorrhage, in an ischemic stroke the blood supply is cut off by the narrowing of the blood vessels. In both cases, however, brain tissue dies off, which can have a long-term negative impact on physical and mental development.

In about five percent of those affected, even life-threatening forms with multiple strokes and cerebral edema occur. In addition, isolated epileptic seizures are possible in rare cases. Although the main symptom of the disease is a sudden onset of devastating headache, if it progresses without complications, there is usually no permanent physical damage. However, the headaches are so severe that they severely impair the quality of life at the time of the attack.

The accompanying symptoms such as nausea, vomiting, a tendency to collapse or states of confusion also lead to a drastic reduction in physical and mental performance. This can cause serious psychological problems in some patients. There is a risk that depression and suicidal thoughts will develop on this basis.

When should you go to the doctor?

In the case of a reversible cerebral vasoconstriction syndrome, the headache is usually so severe that those affected rarely fail to see a doctor. It is also not advisable to refrain from visiting a doctor after a so-called annihilation headache.

It is triggered by a muscle contraction in the head. However, the consequences of a reversible cerebral vasoconstriction syndrome can be so serious that a doctor’s visit should be made immediately. This is especially true if there are other neurological abnormalities. These may include confusion, vision loss, vomiting, seizures, cerebral hemorrhage, or stroke.

A reversible cerebral vasoconstriction syndrome usually resolves within three months. But the level of suffering during this period of time can be considerable. This depends on the duration and intensity of the headache attacks. The possible causes of this phenomenon must be determined, if possible, through the anamnesis. If none are found to explain the condition, this is not uncommon. Reversible cerebral vasoconstriction syndrome has not been sufficiently researched.

If necessary, symptomatic medical treatment must be instituted. This is because reversible cerebral vasoconstriction syndrome is a serious neurological condition that can lead to stroke. The reason for this is to be found in the spasmodic constrictions with which the muscles in the blood vessels in the brain contract.

Treatment & Therapy

Reversible cerebral vasoconstriction syndrome is usually treated with drugs. It should be noted that no guidelines have yet been established for the treatment of the disease. In any case, early diagnosis and appropriate therapy are important. This is primarily a symptomatic treatment.

A central goal of therapy for reversible cerebral vasoconstriction syndrome is to minimize factors that promote vasoconstriction. This includes, for example, avoiding stress, sport and other physical strains. In addition, so-called vasoactive drugs are used. Analgesics and benzodiazepines are also often used.

If patients suffer from epileptic seizures, antiepileptic drugs are also given. The prognosis for reversible cerebral vasoconstriction syndrome is relatively good, as it usually resolves within a few days, weeks, or months.


The reversible cerebral vasoconstriction syndrome can hardly be prevented. It is all the more important to consult a doctor in the event of symptoms so that appropriate treatment of the symptoms can be started.


In the follow-up care of reversible cerebral vasoconstriction syndrome, it is important to take the medications prescribed by the doctor exactly as recommended. While there are no direct preventative measures, careful monitoring of symptoms will help identify a relapse early. In the event of irregularities, patients should consult a doctor as soon as possible.

In addition, by reducing stress and physical strain, they can limit health-endangering factors. If seizures occur, patients must take prescribed antiepileptic drugs. There is also the possibility of using alternative healing methods, whereby precise consultation with the doctor is necessary.

It is very helpful to incorporate such therapy into everyday life, whether it is yoga or other relaxation exercises. The gentle body movement and muscle strengthening lead to a release of hormones, which reduces sensitivity to pain. Many doctors also recommend these exercises because of their psychotherapeutic importance.

The relaxing techniques also make patients feel better mentally. That is why it is important that those affected do their exercises regularly. In this way, their condition improves in the long term. By attending a therapy group and involving family and friends, patients feel even better cared for, which has a beneficial effect on their health.

You can do that yourself

Even if the reversible cerebral vasoconstriction syndrome usually subsides within a few months, the affected patients suffer greatly from the great pain. In addition to medical treatments, alternative therapy methods can be used. These are taught by specially trained experts such as doctors and therapists and can then be independently integrated into everyday life.

Examples of this can be the performance of yoga exercises and other physical therapies. Movement and strengthening of the body release hormones that suppress the sensation of pain. Another positive aspect lies in the psychological importance of such exercises. Mental relaxation, such as meditation, can help prevent depression. It is important to carry out these measures regularly. This is the only way to achieve long-term effects. But also the social environment of affected persons should not be neglected in a holistic treatment.

Since patients often withdraw as a result of the illness, it is important to take countermeasures. Participation in therapy groups and contact with friends and relatives is particularly important during this time. In this way, new courage to live can be found despite the illness.

Reversible Cerebral Vasoconstriction Syndrome