Thunderclap headache and reversible segmental cerebral vasoconstriction associated with use of oxymetazoline nasal spray

Abstract

Oxymetazoline is a sympathomimetic amine found in over-the-counter nasal decongestants. We report a case of chronic use of nasal oxymetazoline associated with thunderclap headache due to reversible segmental intracranial vasoconstriction.

Fig. 1: A: CT angiogram at admission showing axial reformatted images with severe narrowing of the M2 branches of the right middle cerebral artery. B: CT angiogram at admission showing midline sagittal multiplanar reformatted image; done to assess dural sinuses, the image shows multifocal narrowings of the anterior cerebral arteries. C: Right anterior oblique view from a selective cerebral angiogram of the right internal carotid artery showing focal narrowing and dilatation of anterior cerebral artery. D: Follow-up left anterior oblique view from the left carotid artery showing near complete resolution of arteriopathic changes.