title: Long-term outcomes after reversible cerebral vasoconstriction syndrome.
abstract: BACKGROUND
  Long-term outcomes of reversible cerebral vasoconstriction syndrome (RCVS) have not been systematically investigated.
  
  
  METHODS
  The following validated questionnaires were mailed to patients recruited from the RCVS registries of two academic hospitals: headache screening form, Headache Impact Test, Migraine Disability Assessment Test, Barthel Index (BI), EuroQoL (EQ-5D-5L) and Patient Health Questionnaire (PHQ-9).
  
  
  RESULTS
  Of the 191 patients in the registries, 109 could be contacted and 45 responded. Median follow-up time after symptom onset was 78 months. After RCVS resolution, 24 (53%) patients continued to have headache, but the majority (88%) reported improvement in its severity. Thirteen of the 24 patients with persistent headache had a history of migraine prior to RCVS diagnosis. The majority (97.5%) of respondents were functionally independent based on BI scores. EQ-5D-5L showed better scores in the domains of mobility, self-care and usual activities, as compared to pain and anxiety/depression. Patients with persistent headache had significantly higher levels of EQ-5D-5L pain scores. PHQ-9 scores revealed only one patient (3%) with severe depression.
  
  
  CONCLUSIONS
  More than half of RCVS patients will continue to have chronic headaches of mild to moderate intensity that are distinct from the "thunderclap" headaches at RCVS onset. The vast majority regain complete functional ability. However, pain and anxiety/depression are frequent, often aggravated by concomitant chronic headaches, and may be associated with lower quality of life.
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, USA.
authors.forename: Seby
authors.initials: S
authors.lastname: John
authors.affiliation: Department of Neurology, Massachusetts General Hospital, USA.
authors.forename: Aneesh B
authors.initials: AB
authors.lastname: Singhal
authors.affiliation: Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, USA.
authors.forename: Leonard
authors.initials: L
authors.lastname: Calabrese
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, USA.
authors.forename: Ken
authors.initials: K
authors.lastname: Uchino
authors.affiliation: Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, USA.
authors.forename: Tariq
authors.initials: T
authors.lastname: Hammad
authors.affiliation: Neurological Center for Pain, Cleveland Clinic, USA.
authors.forename: Stewart
authors.initials: S
authors.lastname: Tepper
authors.affiliation: Neurological Center for Pain, Cleveland Clinic, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Stillman
authors.affiliation: Department of Neurology, Massachusetts General Hospital, USA.
authors.forename: Brittany
authors.initials: B
authors.lastname: Mills
authors.affiliation: Department of Neurology, Massachusetts General Hospital, USA.
authors.forename: Tijy
authors.initials: T
authors.lastname: Thankachan
authors.affiliation: Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, USA hajjalr@ccf.org.
authors.forename: Rula A
authors.initials: RA
authors.lastname: Hajj-Ali
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D020301:Vasospasm, Intracranial / Q000150:complications*
keywords: Reversible cerebral vasoconstriction syndrome (RCVS); headache; outcomes; quality of life; stroke