A 44-year-old female patient was evaluated in the emergency department for persistent and refractory right temporoparietal headache lasting for 10 weeks. She had a medical history of migraine without aura, eosinophilic esophagitis, anxiety, and was allergic to nonsteroidal anti-inflammatory drugs (NSAIDs). The headache was continuous, of moderate to severe intensity (numeric pain scale 7/10), with occasional more intense paroxysms (9/10), and was partially relieved by sleep. She denied aura and dysautonomic signs. During this period, she had attended different neurologists and was prescribed topiramate 75 mg twice a day. She had been taking eletriptan 20 mg and a combination of analgesics (acetaminophen 400 mg + caffeine 100 mg + ergotamine 1 mg + belladonna alkaloids 0.1 mg) daily, but did not achieve pain relief. The patient was afebrile. The neurological examination, full blood tests, and non-contrast computed tomography (CT) were unremarkable. She was sequentially and unsuccessfully prescribed intravenous (iv) fluid therapy, acetaminophen 1 g iv, metoclopramide 10 mg iv, prednisolone 250 mg iv and sodium valproate 1 g iv, assuming a prolonged migraine status. She was admitted to a neurology ward. After careful review of the patient's complaints, we identified the right supra-auricular region as the most painful area. The pain was exacerbated by touch at the emergence of the auriculotemporal nerve. The patient was evaluated by a stomatologist, who ruled out temporomandibular joint pathology. Regional magnetic resonance imaging (MRI) excluded auriculotemporal nerve entrapment; brain MRI and magnetic resonance angiography (MRA) were also unremarkable. We presumed idiopathic auriculotemporal neuralgia as a plausible secondary diagnosis to migraine and performed an auriculotemporal nerve block with lidocaine 1% 1 cc. She achieved temporal pain relief but retained parietal dull pain, which we attributed to