Reversible cerebral vasoconstriction syndrome: perhaps not so reversible?

Headaches with abrupt onset or with relentless progression are more likely to be pathological and should be investigated. A 38-year-old white, high-functioning woman presented to the emergency department for the 6th time in 12 months with recurrent thunderclap occipital headache and associated nausea. On previous occasions, she had received diagnoses of musculoskeletal pain or migraine after normal investigations and brain imaging. She felt that she had not been completely headache free during the last year, and the thunderclaps signified another protracted period of intense headache.