Reversible cerebral vasoconstriction syndrome associated with vestibular migraine: differential diagnosis and analysis of clinical cases

Headache is one of the most common complaints in neurological practice, significantly affecting patients' quality of life and represents a serious medical and social issue. Among the various causes of headache, special attention should be given to the rare condition known as Reversible Cerebral Vasoconstriction Syndrome (RCVS), which requires timely diagnosis and differentiation from other conditions including migraine and cerebrovascular pathologies. RCVS is characterized by sudden, severe (thunderclap) headaches and reversible narrowing of cerebral arteries, which can lead to serious complications such as ischemic stroke or subarachnoid hemorrhage. Despite its typical clinical picture, RCVS often remains undiagnosed due to its overlap with migraines and other primary headaches. This emphasizes the need for physicians to be aware of the syndrome and how to differentiate it from other conditions. Migraine, especially its vestibular and chronic forms, presents diagnostic challenges as it may mimic or coexist with RCVS, as demonstrated in clinical cases. Exploring the relationship between these conditions and seeking new approaches to their diagnosis and treatment remains an urgent issue in modern neurology. This article presents two cases of RCVS associated with migraine: one involving a 49-year-old woman who developed acute neurological symptoms including vestibulocerebellar syndrome and conductive hearing loss, and the other involving a 30-year-old woman who developed RCVS after prolonged use of nasal vasoconstrictors. Both cases were diagnosed using MRI and angiography and treated successfully. Appropriate treatment led to clinical improvement. Both cases highlight the importance of differentiating between RCVS and vestibular migraine or identifying their comorbid course, as well as the need for a thorough anamnesis, including information on the use of vasoconstrictor drugs. The significance of this issue emphasizes the need for a comprehensive, interdisciplinary approach to treating polymorbid patients. This approach is effectively applied in practice at the LMT-doctor clinic through the integration of doctors from various specialties.