Posters
Presenting Author Academic/Professional Position
Aun Bangash
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Internal Medicine
Academic Level (Author 2)
Medical Student
Discipline/Specialty (Author 2)
Internal Medicine
Academic Level (Author 3)
Medical Student
Academic Level (Author 4)
Faculty
Discipline Track
Community/Public Health
Abstract Type
Case Report
Abstract
Introduction: Headache is a common complaint in clinical medicine, but when it is persistent, orthostatic in nature, and unresponsive to conservative therapy, it warrants evaluation for less common etiologies. This case highlights a compelling diagnostic journey involving intracranial hypertension secondary to transverse venous sinus stenosis (TVSS)—a condition that can be under-recognized, especially in patients without classic risk factors or overt imaging abnormalities. Here, a seemingly benign symptom masked a reversible cause of debilitating headaches, unmasked only through careful clinical suspicion and escalation to advanced neuroimaging. Most importantly, it reminds us that in patients with persistent symptoms, we must look beyond the expected to uncover the exceptional.
Case Presentation: A 40-year-old Hispanic woman with class III obesity and prior gastric sleeve surgery presented with a 2-day history of severe bifrontal headache radiating to the nape of the neck, accompanied by pulsatile tinnitus, transient dizziness, and brief visual blurring. She denied focal neurological deficits, seizures, or loss of consciousness but reported similar intermittent headaches for nearly a year, worsened by standing and coughing. An outpatient CT head suggested bilateral frontal hypodensities concerning acute infarction, prompting transfer to our facility for stroke evaluation. On arrival, she was hemodynamically stable with orthostatic hypotension and had an NIH Stroke Scale score of 0. MRI brain ruled out acute ischemia, and echocardiography was unremarkable. She received IV fluids, aspirin, and atorvastatin, but symptoms persisted. A lumbar puncture revealed an elevated opening pressure of 32 cm H₂O, with marked symptom relief following the removal of 31 mL of cerebrospinal fluid, supporting a diagnosis of intracranial hypertension. Acetazolamide was initiated. Due to symptom recurrence, MR venography was performed and demonstrated severe stenosis of the left transverse venous sinus, which was subsequently confirmed by cerebral angiography. The patient underwent left transverse sinus stenting, resulting in significant and sustained headache improvement. She was discharged on dual antiplatelet therapy, acetazolamide, and a steroid taper, with outpatient follow-up arranged.
Conclusion: This case is a powerful reminder that not all headaches are benign—and not all are what they seem. This encounter emphasizes the need for heightened clinical suspicion when evaluating persistent, orthostatic headaches unresponsive to initial therapy. TVSS remains an under-recognized yet treatable cause of intracranial hypertension. Here, it masqueraded as a chronic tension-type headache before finally revealing itself on MR venography and cerebral angiography. The patient’s dramatic improvement following sinus stenting illustrates not only diagnostic value but also the transformative potential of neurointerventional therapy. This case underscores the importance of thinking beyond the algorithm—of balancing clinical intuition with evidence, and of escalating care when symptoms persist without answers. In an era where "headache" is often dismissed, this story is a call to vigilance: behind the most ordinary symptoms may lie extraordinary pathology—and, with the right approach, a curable one.
Presentation Type
Poster
Recommended Citation
Swamy, Tejaswini; Bangash, Aun A.; Harris, Chloe C.; and Parada, Victoria, "Think Beyond Migraine: A Case of Transverse Venous Stenosis Masquerading as a Common Headache" (2025). Research Colloquium. 14.
https://scholarworks.utrgv.edu/colloquium/2025/posters/14
Included in
Think Beyond Migraine: A Case of Transverse Venous Stenosis Masquerading as a Common Headache
Introduction: Headache is a common complaint in clinical medicine, but when it is persistent, orthostatic in nature, and unresponsive to conservative therapy, it warrants evaluation for less common etiologies. This case highlights a compelling diagnostic journey involving intracranial hypertension secondary to transverse venous sinus stenosis (TVSS)—a condition that can be under-recognized, especially in patients without classic risk factors or overt imaging abnormalities. Here, a seemingly benign symptom masked a reversible cause of debilitating headaches, unmasked only through careful clinical suspicion and escalation to advanced neuroimaging. Most importantly, it reminds us that in patients with persistent symptoms, we must look beyond the expected to uncover the exceptional.
Case Presentation: A 40-year-old Hispanic woman with class III obesity and prior gastric sleeve surgery presented with a 2-day history of severe bifrontal headache radiating to the nape of the neck, accompanied by pulsatile tinnitus, transient dizziness, and brief visual blurring. She denied focal neurological deficits, seizures, or loss of consciousness but reported similar intermittent headaches for nearly a year, worsened by standing and coughing. An outpatient CT head suggested bilateral frontal hypodensities concerning acute infarction, prompting transfer to our facility for stroke evaluation. On arrival, she was hemodynamically stable with orthostatic hypotension and had an NIH Stroke Scale score of 0. MRI brain ruled out acute ischemia, and echocardiography was unremarkable. She received IV fluids, aspirin, and atorvastatin, but symptoms persisted. A lumbar puncture revealed an elevated opening pressure of 32 cm H₂O, with marked symptom relief following the removal of 31 mL of cerebrospinal fluid, supporting a diagnosis of intracranial hypertension. Acetazolamide was initiated. Due to symptom recurrence, MR venography was performed and demonstrated severe stenosis of the left transverse venous sinus, which was subsequently confirmed by cerebral angiography. The patient underwent left transverse sinus stenting, resulting in significant and sustained headache improvement. She was discharged on dual antiplatelet therapy, acetazolamide, and a steroid taper, with outpatient follow-up arranged.
Conclusion: This case is a powerful reminder that not all headaches are benign—and not all are what they seem. This encounter emphasizes the need for heightened clinical suspicion when evaluating persistent, orthostatic headaches unresponsive to initial therapy. TVSS remains an under-recognized yet treatable cause of intracranial hypertension. Here, it masqueraded as a chronic tension-type headache before finally revealing itself on MR venography and cerebral angiography. The patient’s dramatic improvement following sinus stenting illustrates not only diagnostic value but also the transformative potential of neurointerventional therapy. This case underscores the importance of thinking beyond the algorithm—of balancing clinical intuition with evidence, and of escalating care when symptoms persist without answers. In an era where "headache" is often dismissed, this story is a call to vigilance: behind the most ordinary symptoms may lie extraordinary pathology—and, with the right approach, a curable one.
