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Reversible cerebral vasoconstriction syndrome (RCVS) is a disorder presenting with recurrent acute severe headache, with or without focal neurological deficits, secondary to reversible vasoconstriction of intracerebral arteries. Complications include cerebral infarct, convexity subarachnoid haemorrhage, focal intracerebral haemorrhage, seizures and reversible brain oedema.Underlying mechanisms of RCVS are unclear, and management is based on observational data from retrospective studies.The audit aimed to review current practice and develop internal guidelines for diagnosis and management of RCVS.Data was collected retrospectively between January 2021 and October 2024, with 21 patients having a confirmed or presumed diagnosis of RCVS.Results showed variability of initial symptomatic management and imaging timings, with variation in nimodipine dosage and duration, and lack of clarity as to why different regimes were chosen. Additionally, vaping and recreational drug history were often not recorded in the medical notes. Although a provoking medication was found for 6 patients, medication was only withdrawn for 4 patients.We propose implementation of internal guidelines for recognition and management of RCVS with the following outcomes: good documentation of, and withdrawal from triggers, patient advice given and documented, consistency in treatment duration and follow up imaging in 3 months. We intend to re-audit at 1 year.michela. simoni@uhnm.nhs.uk