Headache and Pain Research

Review Article

Temporal Evolution and Multimodal Neuroimaging in Reversible Cerebral Vasoconstriction Syndrome, Arterial Dissection, and Cerebral Venous Thrombosis: Young-Eun Gil; Received April 30, 2026 Accepted May 28, 2026 Published online June 18, 2026; DOI: https://doi.org/10.62087/hpr.2026.0018 [Epub ahead of print]

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Abstract PDF: Cerebrovascular disorders are important secondary causes of headache, but diagnosis can be challenging because headache may be the earliest or only presenting symptom and initial neuroimaging findings are often normal or nonspecific. This review provides a systematic, imaging-focused discussion of three representative cerebrovascular headache disorders: reversible cerebral vasoconstriction syndrome (RCVS), cervical and intracranial artery dissection, and cerebral venous thrombosis (CVT). For each condition, we describe characteristic findings across relevant imaging modalities, including computed tomography, computed tomography angiography, magnetic resonance imaging (MRI), magnetic resonance angiography, vessel wall (VW)-MRI, and susceptibility-sensitive sequences. We also discuss the temporal evolution of imaging findings, which underlies several common diagnostic pitfalls. In RCVS, angiographic vasoconstriction propagates centripetally from distal to proximal vessels, and contrast-enhanced fluid-attenuated inversion recovery imaging can detect blood–brain barrier disruption before vasoconstriction becomes angiographically apparent. In arterial dissection, VW-MRI can show mural features that confirm the diagnosis and may help stratify ischemic risk. In CVT, susceptibility-weighted imaging improves detection of cortical vein thrombosis, a subtype that can be missed on conventional venography. Across all three conditions, single-time-point imaging may be misleading, and serial imaging is often needed to increase diagnostic certainty because interval changes may reveal findings not present on the initial study. By integrating modality-specific findings with their temporal dynamics, this review proposes a practical imaging framework for the early and accurate diagnosis of cerebrovascular secondary headache disorders.

Case Report

Mechanical Thrombectomy in Cerebral Venous Thrombosis Caused by Spontaneous Intracranial Hypotension: A Case Report with Novel Pathological Findings of Fibrin/Platelet-predominant Thrombus: Min Kyoung Kang, Eun Young Kim, Hye-Rim Shin; Headache Pain Res. 2024;25(2):122-127. Published online October 2, 2024; DOI: https://doi.org/10.62087/hpr.2024.0016

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Abstract PDF: This case report presents pathological findings in a rare case of cerebral venous thrombosis (CVT) caused by spontaneous intracranial hypotension (SIH) that was treated successfully with mechanical thrombectomy. The etiologies and prognosis of CVT vary, and CVT resulting from SIH is particularly uncommon and challenging to diagnose and manage. In this case, magnetic resonance imaging revealed signs consistent with both SIH and CVT, which contributed to the patient’s worsening weakness. The patient was treated with a combination of endovascular thrombectomy and epidural blood patch, followed by anticoagulation therapy, and recovered without any complications. A pathological analysis of the retrieved thrombus using hematoxylin and eosin staining showed a high proportion of fibrin and platelets, which could shed light on the mechanism of CVT induced by SIH under conditions of low blood flow due to venous engorgement.

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