Headache as the Only Symptom of a Spontaneous Dural Carotid‐Cavernous Fistula

CASE HISTORY A 59-year-old female with a history of type II diabetes and hypothyroidism presented with a new onset constant daily right-sided throbbing temporal headache. For the first 2 months, the headache had an intensity on a visual analog scale ranging from a 4–5/10 but then increased to a 8–10/10. The headache was less often an occipital aching or sharp pain that radiated from the roof of her mouth to the vertex of her head. Initially, there were no associated symptoms including sinus congestion, eye redness, blurred vision, photophobia, ptosis, nasal congestion or drainage, proptosis, diplopia, nausea, or tinnitus. There was no prior history of headaches. She denied visual aura, jaw claudication, amaurosis fugax, myalgia, or scalp tenderness. She had lost some weight due to loss of appetite because of the headache. A month after the headache started, she noted a loud roaring constant pulsatile tinnitus in the right ear.