The symptoms of a 52-year-old male patient of the university ENT out-patient department began with sudden headaches and itching neck followed by tingling in the mouth, problems with chewing and right-sided deviation of the tongue. In addition there was a history of nicotine use. MRI revealed an intraluminal increase in signal intensity in the right internal carotid artery. Isolated hypoglossal nerve palsy without participation of other cranial nerves is rare so that when headaches simultaneously occur, a dissection of the internal carotid artery is indicated, as in the case presented here.