Iqbal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Introduction: Carotid artery dissection (CAD) is a critical diagnosis in the emergency department (ED). Trigeminal neuralgia, while not uncommon, may cause the patient significant discomfort but generally is not attributed to severe morbidity and mortality. Case Report: We present a case of spontaneous CAD presenting with the classic intermittent “lightning-like” jaw and head pain suggestive of trigeminal neuralgia that was ultimately diagnosed utilizing computed tomography angiogram after multiple visits to the ED. Discussion: Coincidentally the patient had been started on anticoagulation a few days prior and no additional intervention was required. Conclusion: This case report discusses current recommendations for diagnosis, treatment, and long-term prognosis of CAD.