Secondary headaches pose a diagnostic challenge, particularly when they mimic common primary headaches or psychiatric conditions. Headaches attributed to cavernous angiomas (cerebral cavernous malformations) are rare but important, classified under code 6.3.4 in the International Classification of Headache Disorders, third edition (ICHD-3). While often asymptomatic, cavernous angiomas may cause neurological symptoms, seizures, and occasionally headaches. The causal link between cavernomas and headaches remains debated due to limited data and symptom overlap. However, a temporal correlation with lesion detection and improvement after surgery supports a direct association per ICHD-3 criteria. A 32-year-old man presented multiple times with a continuous left frontotemporal headache of dull, sometimes pulsatile quality, worsened intermittently. Initially misdiagnosed with panic disorder linked to stress and elevator-related anxiety, no neuroimaging was performed initially. A sinus computed tomography (CT) scan incidentally revealed a left temporal lesion, prompting a brain magnetic resonance imaging (MRI) that identified a 2.2 × 2.3 × 2.2 cm cavernous angioma near mesial temporal structures. The lesion showed characteristic features without signs of recent hemorrhage but with hemosiderin deposits indicating prior microbleeds. The proximity to the hippocampus likely explained the patient’s seizure-like episodes and headache. Surgical resection was complete, with full headache resolution and no neurological deficits postoperatively. The previously presumed panic attacks were reinterpreted as epileptic seizures related to mesial temporal lobe epilepsy. The patient was started on carbamazepine with ongoing management. This case underscores the importance of neuroimaging in new-onset headaches and the need to differentiate secondary headaches caused by structural brain lesions from primary headache or psychiatric disorders, highlighting ICHD-3 criteria application.