Abstract text (incl. figure legends and references)

Question― Prevalence of migraine among patients with reversible cerebral vasoconstriction syndrome (RCVS) considerably exceeds prevalence in the general population. However, its impact on the clinical and radiological presentation of RCVS remains unknown. We aimed to compare clinical characteristics and complications in RCVS patients with and without a history of migraine.

Methods― In a pooled cohort of 345 French patients with RCVS, we compared patients with and without a history of migraine regarding the clinical presentation, rates of neurological complications, and the functional outcome at 3 months.

Results― Among 345 patients, 92 (27%) reported a history of migraine. Migraine was independently associated with the absence of thunderclap headache at onset (OR 1.8, 95% CI 1.0-3.3; p=0.049) and with absence of recalled sexual triggers (OR 2.4, 95% CI 1.3-4.7; p=0.008). History of migraine with aura was an independent risk factor for aura during the course of RCVS (OR 6.4, 95% CI 2.0-20.4; p=0.002), while history of migraine without aura was independently associated with the occurrence of subarachnoid hemorrhage (SAH; OR 2.0, 95% CI 1.0-3.7; p=0.037) and multiple cervical artery dissections (mCAD; OR 4.1, 95% CI 1.1-14.6; p=0.032). The functional outcome was equal in both groups, with a modified Rankin scale score of 0-1 in ≥90% of patients.

Conclusions― Migraine seems to influence clinico-radiological features of RCVS, predisposing for an atypical clinical presentation and an elevated risk for SAH and mCAD. Larger multi-centric studies are warranted to confirm these findings.