Dural arteriovenous stula (DAVF)-related headaches are most commonly observed in middle-aged adults, with the median age of onset occurring in the fth to sixth decades of life [5]. These headaches are often part of a more aggressive clinical presentation, which may include the sudden onset of severe headache, sei­zures, and various forms of intracranial hemorrhage, such as intraparenchymal, sub­arachnoid, or subdural bleeding. The headaches associated with DAVFs are typically described as extremely severe and may present with a variety of patterns [6]. They are often localized to the occipital or frontal regions but can also be diffuse. A thun­derclap headache, characterized by a sudden and intense onset, may mimic sub­arachnoid hemorrhage and can signal cortical venous reux—necessitating urgent evaluation. Pulsating headaches are also common and may be accompanied by an audible bruit, reecting turbulent blood ow within the stula. Unilateral orbital or retroorbital headache is frequently associated with cavernous sinus DAVFs and is often accompanied by ocular signs, such as proptosis, conjunctival injection, or cranial nerve palsies. In some patients, headaches may worsen with changes in head position, indicating a disruption in venous drainage. Additionally, headaches associ­ated with pulsatile tinnitus—especially in cases involving the transverse or sigmoid sinuses—are a hallmark of DAVFs. Some cases may mimic chronic tension-type or migraine-like headaches, which can lead to misdiagnosis and delays in appropriate treatment. Notably, ocular symptoms in the context of nonmigrainous headache may suggest a carotid-cavernous stula, whereas migrainous features may point toward other DAVF locations. Pulsatile tinnitus and symptoms of increased dural sinus ow are particularly characteristic of stulas located in the transverse and sigmoid sinuses [7, 8].