Objective To analyze the characteristics of the common first attack of headache in patients with cerebral venous sinus thrombosis (CVST). Methods The clinical data of 51 patients who were diagnosed as CVST with MR venography (MRV)or DSA were collected retrospectively. The patients were divided into either a acute group (≤3 week,n= 32)or a chronic group (>3 weeks, n=19). Results (1)The age of onset of symptoms in these patients was 20 to 40 years,and most of them were females. Of all the first symptoms,headache ranked first,accounting for 84. 3%(43/51 );headache only accounted for 52. 9%(27/51 ),headache with other symptoms (ophthalmic symptoms, hemiplegia,and aphasia,etc. )accounted for 31. 4%(16/51 ),and other symptoms such as epilepsy, paralysis,and ophthalmic symptoms accounted for 15. 7%(8/51). (2)The proportion of headache only as the first symptom in the acute group was higher than that in the chronic group (65. 6% vs. 31. 6%,P<0. 05), and the proportion of chronic headache with other symptoms as the first symptom in the chronic group was higher than that of the acute group (P<0. 05). In addition,the proportion of the first symptom including ophthalmic manifestations in the chronic group was higher than that of the acute group (P <0.01 ). (3)Forty-three patients with headache,dull headache or distensible pain accounted for 72. 1%(31/43), thunderclap headache accounted for 11. 6%(5/43),and other kinds of headache accounted for 16. 3%(6/43),however,there were no significant differences about the types of headache between the two groups (all P>0. 05 ). Conclusion Young patients without previous history of migraine,especially women of childbearing age with sudden onset and progressive worsening headache,and the patients with idiopathic intracranial hypertension,CVST should be considered as an important possibility.