Introduction: Headache is the sole presenting symptom in 20% of patients with cerebral venous sinus thrombosis (CVST). We aimed to assess the characteristics and outcome of CVST patients with isolated headache.
Methods: In a retrospective study, we included all adult patients with diagnosis of CVST from 2012 to 2016, in Namazi hospital, Shiraz, Iran. Demographic, radiologic and clinical data and discharge outcome were compared between the patients with isolated headache and the others through chi square, fisher exact and logistic regression tests.
Results: Among 174 patients, 45 (26.0%) presented with isolated headache. Isolated headache was more frequent in men (P-value=0.048). It was not associated with the interval between symptom onset and diagnosis of CVST (P-value=0.299). Previous venous embolic events were reported in patients with isolated headache more than others (P-value=0.01). Thrombophilia was more frequent in patients with isolated headache (P value=0.040). Right lateral sinus involvement was more common (P-value=0.012) and early intracranial hemorrhage (ICH) (P-value=0.006), venous infarct (P-value=0.009) and expansion of ICH (Pvalue=0.022) occurred less frequently in patients with isolated headache. None of these patients expired in hospital course and overall, they had better outcome than the others (P value<0.001). After adjustment for other variables, isolated headache did not remained as a predictor of outcome in multivariable model.
Conclusion: Risk of parenchymal lesions and poor outcome is lower, but exists in CVST patients with isolated headache. Thus, CVST should be considered as a differential diagnosis in patients who refer with sole headache in order to prevent the unfavorable outcome and delay in diagnosis.

Isolated Headache and its Association with the Clinical and Radiological Characteristics and the Outcome of Patients with Cerebral Venous Sinus Thrombosis