Throbbing headache is not always migraine; it can be serious

Cerebral venous thrombosis (CVT) is a rare but serious venous thrombotic disorder in the general population. It has an estimated annual incidence of about 4-5 cases per 1 million persons. It is more common in females than males. We describe below a case of a 49-year-old female patient who presented to the emergency room with 1 day history of right-sided throbbing headache associated with vomiting. Computed tomography (CT) scan of the head without contrast showed venous sinus thrombosis involving the posterior sagittal sinus, extending into the dominant right transverse sinus, which was confirmed by CT head with intravenous contrast. The patient was immediately started on anticoagulation with therapeutic low-molecular-weight heparin that was transitioned to warfarin. Follow-up CT head 3 months later showed resolution of the thrombus and recanalization of the affected veins. A high level of suspicion for a rare disorder like CVT should be considered as part of the differential diagnosis of headache, which is a commonly encountered problem, because immediate anticoagulation treatment can prevent fatal complications.