Chronic daily headache associated with nutcracker syndrome: a case report and narrative review

To explore the potential association between chronic daily headache (CDH) and nutcracker syndrome (NCS) and to summarize the clinical and imaging characteristics of reported cases. We present a case of CDH associated with NCS and provide a narrative review of published cases. Literature was searched in PubMed and Web of Science using the keywords “nutcracker” and “headache” from database inception to June 1, 2024. Reference lists of relevant articles were also screened. Data extracted included patient demographics, clinical features, imaging findings, treatment approaches, and reported outcomes. In addition to the present case, previously reported cases were summarized, yielding a total of 30 patients for descriptive analysis. Among the 30 patients, 2 were male and 28 were female (male: female = 1:14). Patient ages ranged from 4 to 60 years, and the course of the disease was 1.5-9 years. According to WHO criteria, 26 patients had normal BMI (18.5–24.9), and 4 were overweight (25–29.9). Most patients presented with chronic daily headache and left renal vein compression was commonly reported on imaging. Symptomatic pharmacological treatments were reported in many cases, with variable individual responses. Some patients experienced improvement, while others had limited or no relief. Non-drug therapies, such as lumbar puncture, venous embolization, or surgical interventions, also produced variable outcomes. These findings are based on published case reports and may not be generalized to all patients with NCS-related headache. All data are presented descriptively and do not imply quantitative inference. Given the limited number of published cases and the inherent selection bias of case reports, these findings should be interpreted cautiously and cannot be generalized to the broader population. NCS may represent a potential secondary cause of chronic daily headache. In patients with persistent headache of unclear etiology, especially when symptoms worsen in the Trendelenburg position, evaluation for left renal vein compression may be considered. Further studies are needed to clarify the underlying mechanisms and optimal management strategies.