Spontaneous dissection of a vertebral artery is uncommon, but potentially harmful and initially easily misdiagnosed as ordinary headache, neck pain or dizziness. The condition may progress with infarctions in the brainstem and cerebellar areas and ataxia, nystagmus, Horner syndrome, dysarthria, cranial nerve palsy or hemiparesis. We report an initially misdiagnosed case and remind about the clinical clues which lead to a correct diagnosis: young age, no risk factors for thromboembolism, the typical clinical findings and the presence of neck pain.