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Background and Aims Cerebral venous thrombosis (CVT) is a rare complication of dural puncture and it is often related to the presence of predisposing factors, such as pregnancy and puerperium. Because the clinical symptoms of CVT can resemble those of a post-dural puncture headache (PDPH), the diagnosis may be delayed.

Methods Case report.

Results A previously healthy 30-year-old woman Gravida 1 Para 0 presented in active labour at 40 weeks gestation, requesting epidural analgesia. An unintentional dural puncture occurred with an 18G epidural needle and a catheter was placed in the subarachnoid space for analgesia. The vaginal delivery occurred two hours later and it was uneventful. The following day, the patient complained of a frontal-occipital orthostatic headache that improved when positioned supine, with no other symptoms. Pain management with analgesic drug therapy was successful for the first two days, but thereafter she began to again complain of a headache, with the same positional component. An epidural blood patch was performed with relief of symptoms. She was observed by the neurology team which ruled out any neurological deficits but still ordered a brain CT. Imaging was consistent with CVT and the patient was started on enoxaparin. Thrombophilia workup was found to be negative. She remained asymptomatic and was discharged home 5 days later with transition of the anticoagulation therapy to dabigatran.

Conclusions This case highlights the importance of considering CVT in the differential diagnosis of headache in the post-partum period. Despite its impact on quality of life, PDPH doesn’t carry the life-threatening risk of CVT.