A case of postpartum reversible cerebral vasoconstriction syndrome due to excessive use of vasoconstrictive nasal spray

Abstract

Reversible cerebral vasoconstriction syndrome is characterized by sudden severe headaches, imaging evidence of vasoconstriction, and resolution of symptoms within three months. Reversible cerebral vasoconstriction syndrome is common in women of reproductive age and can be triggered by pregnancy, postpartum conditions, migraine, vasoactive drugs, and vascular injuries. In this case report, we describe a 32-year-old postpartum woman with a history of migraines and smoking who developed reversible cerebral vasoconstriction syndrome after excessive use of a self-administered over-the-counter nasal spray containing naphazoline hydrochloride. Onset of the patient’s headaches occurred after administration of the spray at a dose and frequency significantly exceeding the recommendations in the package insert. Chronic smoking and postpartum vascular changes likely contributed to her condition. Careful monitoring of vasoconstrictive medication use and vascular risk factors during the perinatal period is essential to prevent reversible cerebral vasoconstriction syndrome.