Fibromuscular dysplasia: an update for the headache clinician.

BACKGROUND

Fibromuscular dysplasia (FMD) is an uncommon vascular disease that presents with stenosis, aneurysm, dissection, beading, and tortuosity of medium-sized arteries. It primarily manifests in the renal and extracranial carotid and vertebral arteries, and is associated with major vascular events such as carotid artery dissection, renal artery dissection, ruptured aneurysm, transient ischemic attack, stroke, and myocardial infarction (due to coronary artery dissection).

DISCUSSION: There is a wide spectrum of disease severity among FMD patients. Symptoms of FMD are related to the vascular beds involved and the severity of arterial stenoses. Headache is an extremely common and important symptom reported by patients with FMD, although the precise mechanism of headache in this population is not yet known.

CONCLUSION

This review summarizes the most recent literature regarding FMD, including epidemiology, clinical manifestations, imaging practices, and treatment. Special attention will be paid to the association of headaches and FMD. Correct diagnosis, optimal medical management, and appropriate referral for vascular intervention are vital elements of the treatment of patients with FMD. There is a great need for more clinical research regarding the epidemiology, pathophysiology, and optimal treatment of headache in the FMD patient population.