The overwhelming majority of patients present with headache. The presentation patterns are secondary to the underlying pathology associated with cerebral thrombosis. Local ischemia from impaired venous drainage and secondary edema and hemorrhage leading to intracranial hypertension can have different deficits, but in general cause intracranial hypertension and thereby pain.

The headache character is unique from classic migraine in that it typically worsens with effort such as valsalva maneuver and when recumbent.  In addition, up to 40% of patients presented with first time seizure. Patients can also have focal deficits and changes in mental status on more severe presentation, but these cases are not as likely to be missed as they would get further investigation and more advanced imaging than an isolated headache or first time seizure patient might receive.