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A 57-year-old male presented with a thunderclap headache with right sided pain and new right pulsatile tinnitus. He had a history of right lateral transverse venous sinus thrombosis (VST) three years prior which led to chronic migraine. The headache worsened with posture, movement and valsalva manoeuvres. His preference was to lie still in bed.Neurological examination, including fundoscopy, was unremarkable, however he had a bruit that could be auscultated at right posterior auricular region.Magnetic Resonance Venography demonstrated new changes consistent with a dural arteriovenous fistula (DAVF) involving the right lateral transverse sinus, along with chronic sequelae in the right medial transverse sinus.His care was transferred to neurosurgery, and he underwent radiologically guided embolization of a right transverse-sigmoid DAVF, which resulted in complete resolution of symptoms.This case alerts Neurologists to the co-association of VST and DAVF with a proposed bidirectional relationship. Potential mechanisms include venous hypertension activating pre-existing shunts and angiogenesis secondary to venous congestion.1 Interestingly, CVST has been identified retrospectively in 19.8% of patients with DAVF in a case series.1 DAVFs can develop months or even years following CVST, highlighting the importance of long-term monitoring and requirement for detailed clinical assessment.1 2 References Zhao X, et al. Dural AV fistulas with or without CVT: analysis of 511 patients. Neurosurgery 2024.Kang D, et al. Dural AV fistula post-CVST: case report. J Neurosurg Case Rep. 2024.rajesh.ambati@nhs.net