Central venous sinus thrombosis (CVST) is a rare cause of headache and stroke but has a wide clinical spectrum of presentations, including headache, seizures, focal neurological signs and alteration in consciousness, which can present in isolation or in various combinations. CVST is a difficult diagnosis to make in clinical practice but advances in neuroimaging allows for faster and more precise diagnosis, but it can still prove elusive. Non-infectious CVST are now more common that post-infectious, for which there are a variety of causes and risk factors in the clinical history that can suggest the diagnosis. The authors present a case that highlights the difficulty in diagnosis and identifies an association with a common eating disorder. A literature review discusses the complexities of presentation, aetiology, imaging and the current evidence on management.