Behind the Headache: A Case of Cerebral Venous Thrombosis Associated With Hormonal Contraceptive Use

Abstract

Cerebral venous thrombosis is an uncommon but potentially life-threatening condition. We present the case of a previously healthy 26-year-old woman who developed cerebral venous thrombosis while using a combined hormonal contraceptive. She presented with progressive headaches unresponsive to analgesics. Imaging confirmed thrombosis in the left transverse and sigmoid sinuses and the left internal jugular vein. Anticoagulation was initiated with full resolution of symptoms and thrombus. Extensive thrombophilia screening was negative, and combined hormonal contraceptive use was identified as the main risk factor. The patient transitioned to a progestogen-only method. This case highlights the need to consider cerebral venous thrombosis in women with atypical headaches using combined hormonal contraceptives. It also emphasizes the importance of personalized contraceptive counseling based on thrombotic risk factors.

Keywords: adverse effects; case report; cerebral venous thrombosis; combined hormonal contraceptives; contraceptive counseling; secondary headache; venous thromboembolism.

Figure 1. ECG performed in the emergency department.

Twelve-lead electrocardiogram (ECG) demonstrating normal sinus rhythm at 84 bpm, with PR interval of 176 ms, QRS duration of 88 ms, and corrected QT interval (QTc) of 408 ms. No significant abnormalities observed.

Figure 2. CT venography in the emergency department.

Axial cerebral computed tomography (CT) venography showing a filling defect in the cranial segment of the left internal jugular vein (yellow arrow) consistent with venous thrombosis.