Reversible cerebral vasoconstriction syndrome (RCVS) is a rare but significant cause of intracranial arteriopathy and stroke in young adults, occurring at an estimated incidence of 3 per million adults. It encompasses a spectrum of disorders radiologically characterized by reversible narrowing and dilation of intracranial arteries, often triggered by vasoactive drugs or the postpartum period. The hallmark clinical feature of RCVS is thunderclap headache with or without other neurological signs. Pathogenesis of RCVS is still unclear, though endothelial dysfunction and sympathetic hyperactivation are hypothesized to be key mechanisms. Diagnostic challenges arise from variable initial imaging findings. Since vasospasm proceeds centripetally, initially involving distal small pial and cortical arteries, initial brain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) may miss it in significant percentages. However, early signs such as vascular FLAIR hyperintensities may be visible on T2/FLAIR sequences before vasospasm onset. Catheter angiography is the gold standard, despite potential initial normalcy, and it could be used to assess vasospasm reversibility post intra-arterial vasodilator administration. Treatment focuses on symptom management and addressing triggers, and Nimodipine is often administered orally or intra-arterially as primary therapy. Further research is needed to better understand the complex pathophysiology of RCVS and to optimize clinical management strategies.