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Abstract Details

Building a Case for Magnesium in Reversible Cerebral Vasoconstriction
Headache
P4 - Poster Session 4 (5:30 PM-6:30 PM)
7-008
We aim to describe a case of refractory headache associated with reversible cerebral vasoconstriction syndrome (RCVS) successfully treated with magnesium.

RCVS is a poorly understood and underdiagnosed headache syndrome with potentially severe neurologic consequences. Calcium channel blockers (CCB) are typically used to treat headaches in RCVS. For patients who cannot tolerate CCB or have refractory headaches, treatment options are limited. Although magnesium is commonly used in post-partum vasculopathies, its use in RCVS is not established. 
A 64-year-old woman with a history of migraine with aura suffered 10 days of recurrent severe thunderclap headaches, different from her typical migraines. She felt she was being hit in the head, reaching maximal pain within seconds followed by nausea. She had constant, less severe, throbbing right frontal or occipital pain between thunderclap headaches. She presented to the emergency department after her usual over-the-counter headache regimen was ineffective.
Neurologic exam was normal. Computed tomography showed bilateral frontal subarachnoid hemorrhage. Magnetic resonance angiography showed segmental narrowing of the left vertebral and basilar arteries consistent with RCVS. She could not tolerate 80mg or 40mg of verapamil due to dizziness and bradycardia. Triptans and non-steroidal anti-inflammatories were contraindicated due to vasculopathy and hemorrhage. She was given intravenous (IV) magnesium 1mg which significantly improved her pain. She received IV magnesium daily over three days with repeated benefit. She was discharged on magnesium glycinate 400mg daily for headache prevention.
This case illustrates that magnesium is a low risk, effective treatment option for refractory thunderclap headaches from RCVS in patients with concurrent migraine. This builds on prior case reports of IV magnesium use in RCVS headache recurrence after initial treatment with verapamil. Future research is needed to examine the precise mechanism of action of magnesium providing headache relief in RCVS and whether magnesium is particularly useful in patients with concurrent migraine.
Authors/Disclosures
Mallory N. Luckey, MD
PRESENTER 		Dr. Roberts has nothing to disclose.
Elizabeth Pedowitz, MD (Memorial Sloan Kettering Cancer Center) No disclosure on file
Anna Pace, MD (Mount Sinai School of Medicine) Dr. Pace has received personal compensation in the range of $0-$499 for serving as a Conference speaker with 好色先生.