Headache: A potential sequela of posterior reversible encephalopathy syndrome

Introduction

Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder consisting in cerebrovascular dysregulation with acute neurological symptoms, including headache. However, there is a paucity of data that point to headache as a sequela of PRES. We aimed to explore its prevalence, characteristics, and impact.

Methods

We retrospectively included all consecutive patients with PRES attended at our institution from April 2018 to January 2022. We collected demographic and clinico-radiological data from the acute phase. During a mean follow-up time of 16 (14) months, we assessed the presence of headache after PRES and evaluated its impact using validated questionnaires.

Results

Of the 27 cases detected, after excluding 16 patients (11 deceased and 5 lost to follow-up), we evaluated 11 patients with a mean age of 38 (14) years; 63.6% were female. After PRES resolution, 9/11 (81.8%) patients presented headache, with migraine-like features in 8/9 (88.9%). Seven patients completed validated questionnaires; on the Migraine Disability Assessment scale, 71.4% (5/7) had moderate–severe disability. The Short Form-36 Health Survey dimensions of general health, physical role, and vitality reflected a deterioration in the quality of life.

Conclusions

Our data suggest that headache is a potential sequela of PRES that could imply subsequent disability. Migraine-like features point to the existence of shared pathophysiological mechanisms with migraine, which may mainly involve vascular and endothelial functions; however, more studies are needed.