SYNOPSISThe neurosurgical findings and neuropathological confirmation of symptomatic congenital constriction of the superior sagittal sinus 4 cm rostral to the torcular Herophili is reported. This was caused by infantile occipital parietal overlap in 21 cases of intractable migraine. The constriction of the superior sagittal sinus is initiated during parturition and results in an atresia and post stenotic dilatation of the sinus which leaves its specific imprint in man's occiput. Turbulence within this segment of the sinus is perceived in the trigeminal sensory nerve distribution. Fontanel craniectomy appears to yield relief of head pain in intractable migraine and in persistent pseudotumor cerebri.