21y male presents with insidious onset, progressively worsening frontal dominant holocranial headache × 1 year. It worsens on coughing, straining and often wakes the pt. up from sleep in the early morning.

6 months later, he develops a progressive blurring of vision --> colour desaturation --> ending up near blind by the time he came to us.
His personality has changed over this 1 year and he has become more jocular than usual as per family. He is strangely unconcerned -> his LOV.

What is your localization +/- clinical diagnosis ?

This hx is suggestive of barndoor RICT, likely due to frontal SOL.
We found papilledema on fundoscopy with loss of OKN in both eyes suggestive of severe LOV.
MRI - huge frontal SOL

What was the teaching point?
This patient was being treated as migraine for nearly a year!
One should be very careful to rule out secondary headaches before dx primary ones!