Cerebral venous sinus thrombosis (CVT) is becoming recognized as a more common and treatable disorder in young patients. Unfortunately, headaches are overwhelmingly common complaints in the emergency department (ED), so CVT can be easy to miss since it has confusing clinical and imaging findings. Emergency medicine (EM) physicians should be aware of various clinical presentations as well as risk factors. While it only represents about 1% of all strokes, its higher proportion of stroke in young patients makes it more relevant to the EM provider.  Interestingly, an incidence of 9.3% of CVT was found on a pathology study, suggesting it is very under diagnosed in the ED.