A 36-year-old female presented with a history of chronic daily headaches that had worsened over the past six months. The patient described the headaches as dull, generalized, and of moderate intensity, further exacerbated by physical exertion and coughing. There were no signs of radiation, aura, nausea, or focal neurological deficits. The patient's medical history included attention-deficit hyperactivity disorder (ADHD), for which dextroamphetamine-amphetamine ER 20 mg daily had been prescribed. Initial outpatient imaging, including a CT head (with and without contrast), an MRI of the brain (with and without gadolinium), and a magnetic resonance venography (MRV), was reported as normal. However, due to the persistent nature of her headaches, a diagnostic cerebral angiogram with venogram and 3D reconstruction was performed.

Vital signs recorded were: temperature, 37.3°C; heart rate, 65 bpm; respiratory rate, 20; blood pressure, 120/74 mmHg; oxygen saturation, 99%; and BMI, 22.15 kg/m². The patient’s physical examination revealed a supple neck, clear chest, normal heart sounds, and a non-tender abdomen with no palpable masses. There was no oedema in the extremities. The neurological exam was normal, including cranial nerves, motor and sensory function, reflexes, coordination, gait, and fundoscopy. Laboratory investigations were unremarkable. The cerebral angiogram revealed moderate-to-severe stenosis of the right transverse sinus and ipsilateral internal jugular vein.