We present the case of a 71-year-old man who presented to us with unilateral lower motor neuron hypoglossal palsy along with the characteristic occipital headache. He himself forwarded a paper on occipital condyle syndrome to the clinician who initially reviewed him. Later the patient underwent a series of investigations that confirmed the diagnosis of underlying prostatic carcinoma with widespread metastasis to bones including the base of the skull. Seven months after the diagnosis he is doing well, his headache is much better and the tongue deviation is stable. He was initially treated with tapering doses of dexamethasone and is currently receiving the depo gonadorelin analogue leuprorelin.