Superior sagittal sinus thrombosis presented as a migraine headache with normal D-dimer: a case report and literature review.

Superior sagittal sinus thrombosis (SSST) is a rare cerebral venous sinus thrombosis. It involves blood clot formation in the superior sagittal sinus. This leads to increased intracranial pressure. A remarkable case highlights SSST presenting as a migraine with normal D-dimer levels. A 49-year-old woman had severe unilateral headaches, photophobia, dizziness, and neck tension. She had a migraine history and hypertension. The patient was a heavy smoker and used oral contraceptives. Examination revealed neck stiffness and blood pressure of 150/90 mmHg. CT and D-dimer tests were normal. Magnetic resonance venography (MRV) revealed SSST and a lacunar infarction. Anticoagulation therapy was initiated, leading to recovery and discharge after 11 days. This case underscores the diagnostic challenge of SSST presenting as a primary headache disorder. It emphasizes the need for thorough evaluation despite normal laboratory results in at-risk individuals. Clinical relevance: This case highlights the importance of advanced neuroimaging for diagnosing unusual headaches.