IntroductionReversible cerebral vasoconstriction syndrome (RCVS) has a heterogenous clinical and radiological presentation. We investigated whether RCVS complications vary according to age.Patients and methodsIn a pooled French cohort of 345 patients with RCVS, we assessed (1) rates of clinical and radiological complications, and (2) the functional outcome at 3 months according to age as a continuous variable, and in young patients aged ≤ 49 years versus those aged ≥ 50 years. TheCommission Nationale Informatique et Libertéand the local ethics committee approved this study (registration number: 202100733).ResultsThe risk for any focal deficit and for any brain lesion were independently associated with increasing age (OR 1.4, 95% CI 1.1–1.8;p= 0.014, and OR 1.6, 95% CI 1.2–2.1;p< 0.001, respectively). Subtypes of brain lesions independently associated with increasing age were subarachnoid haemorrhage (OR 1.7, 95% CI 1.3–2.3;p< 0.001) and intracerebral haemorrhage (OR 1.5, 95% CI 1.1–2.2;p= 0.023). Frequency of cervical artery dissections peaked at age 30–39, and young age was independently associated with cervical artery dissections (OR 13.6, 95% CI 2.4–76.6;p= 0.003). Age had no impact on the functional outcome, with a modified Rankin scale score of 0–1 in > 96% of patients.ConclusionAge seems to influence rates and types of complications of RCVS, with young age being associated with cervical artery dissections, and increasing age with haemorrhagic complications. If confirmed in larger prospective studies, recognition of age-specific patterns might help to guide clinical management and to identify complications in cases of RCVS and vice versa.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00415-023-11708-z.