Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 7 0 2024 09 10 12 17 Alireza Bahmani Department of Emergency Medicine, Khatam Al-Anbia Hospital, Zahedan University of Medical Sciences, Zahedan 2024 08 14 Background: Aortic dissection is an uncommon medical emergency with an incidence rate of approximately three per 100,000 people; the diagnosis of aortic dissection is often missed in the absence of chest pain in approximately 6% of cases. Case Presentation: There was a 53-year-old man with a history of migraines and high blood pressure who woke up in the morning with a severe headache and was diagnosed with carotid dissection and thoracic aortic dissection involving the ascending aorta and descending aorta. Conclusion: Aortic dissections rarely present with severe headaches as their initial symptom, but aortic dissections with carotid artery dissections are typically accompanied by headache; it is important to keep in mind that the sudden onset of a frontal headache may necessitate sonography of the carotid arteries and echocardiography. https://ajs.tums.ac.ir/index.php/ajs/article/view/275