Case report
On November 25th, 2021, a 32-year-old man with a 20-year history of chronic headaches was referred to the National Institute of Neurosciences & Hospital. Apart from that, the physical checkup was normal. Since 2002, he has had constant and recurring headaches, occurring 2-3 times each week. The headaches were reported as forehead pain that did not extend to his eye or any other body part. The attacks lasted 30 to 45 minutes on average. These headaches frequently occurred in the afternoon and were not characterized by eye redness or weeping. The headaches were so bad that he could not stand it any longer. Except for NSAIDs, which only eased the pain to a minor degree, no therapies were helpful before consulting with a physician. He was previously diagnosed with tension headaches and also treated as migraine for dull on-off headaches. He had previously been prescribed paracetamol, NSAIDs, Propranolol, methysergide, antihistamines anti-anxiety and sedative medication and naproxen sodium were among the earlier ineffectual treatments. A clinical interview, the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI) were all used in a comprehensive psychiatric assessment. The psychological perception was the situational anxiety resulting from her disease, with no underlying psycho-emotional dysfunction. On numerous occasions, physicians have recommended that he undergo contrast-enhanced computed tomography (CT scan) and magnetic resonance imaging (MRI), but he has always planned to do it later. He experienced acute watery diarrhoea recently on 10 November 2021, and lab tests revealed Hb-15.90 g/dL, WBC-28.93 x 109/L, Platelets-342 x 109/L, ESR-16 mm in the first hour. Sodium 133 mmol/L, potassium 5.4 mmol/L, creatinine 2.3 mg/dl. The electrocardiogram, liver/renal function, clotting profile, chest X-ray, and liver/renal function were normal. But this acute diarrhea period he had associated severe headache so he underwent contrast-enhanced computed tomography (CT scan) (Figure:01) and Magnetic Resonance Venography (MRV) (Figure:02); which revealed the jugular venous system of the left side is not visualized and the right side jugular venous system is prominent and deep veins and dural venous sinuses appear normal which suggestive of congenital agenesis of jugular venous system of left side. Due to financial difficulties, he has not yet undergone an intervention or any other procedure. He still had a persistent headache, but the patient remained constant during the follow-up visit the following week.