Published 2023-11-22

Currently, the causes and mechanisms contributing to the development of dysplasia are not known, so it is not possible to propose a single effective method of treating dysplasia.

Antiplatelet therapy

Thrombotic and thromboembolic events may occur in patients with FMD, even in the absence of dissection or aneurysm. Antiplatelet medications are warranted for both symptomatic and asymptomatic FMD.

In the absence of contraindications, antiplatelet therapy (i.e., aspirin 75–100 mg daily) is warranted in patients with FMD to prevent thrombotic and thromboembolic complications.

Treatment of hypertension

Hypertension is common in patients with FMD and is either due to essential hypertension or due to renovascular hypertension associated with renal artery involvement. Control of hypertension is particularly important in patients with FMD who have intracranial aneurysms as well as aneurysms in other locations. Some antihypertensive medications may also be effective as preventive therapies for migraines.

Half of patients report headaches at least once a week. Although migraines are the most common type of headache among patients with FMD, headaches can also be associated with uncontrolled hypertension. Migraines may occur in patients with FMD even in the absence of cerebrovascular involvement. As with all migraine patients, the approach to treating migraine in patients with FMD may include lifestyle modifications to avoid triggers, preventive therapies, and medications to prevent migraines.

Pulsatile tinnitus has recently been recognized as a common manifestation of cerebrovascular FMD. Therapy may be helpful in some patients with more severe symptoms, although experience in the treatment of pulsatile (vs. nonpulsatile) tinnitus is limited. Consultations with an audiologist and otolaryngologist may be helpful in assessing hearing and assessing other causes of pulsatile tinnitus beyond FMD.

Smoking cessation has been shown to have many health benefits in the general population. Patients with FMD who smoke have a higher incidence of aneurysms and more adverse events, including the need for vascular procedures (according to the US registry). All patients with FMD who continue to smoke should be strongly encouraged to stop smoking.