This is a case report of a 33-year-old female with a history of migraines who presented with her typical migraine symptoms for three days. However, she also began to notice diplopia and drooping of her right eyelid, which were symptoms she had never had in the past with migraines. MR angiography showed a 4x3x5 mm posterior communicating artery aneurysm that was likely compressing the right third cranial nerve. She was taken to the operating room by neurosurgery and underwent clip ligation of the aneurysm with improvement in symptoms. It is important to always assess for new signs and symptoms in patients presenting to the Emergency Department who are complaining of their “typical” migraine symptoms because this may indicate previously undiagnosed pathology that will require intervention to prevent negative outcomes.TopicsCerebral aneurysm, cranial nerve palsy, ptosis.