Cocaine is a widely abused illicit stimulant with well-documented cardiovascular and neuropsychiatric effects. Among its neurological consequences, headache is a less frequently recognized yet clinically significant manifestation. This chapter explores the clinical features, diagnostic approach, and management strategies for cocaine-induced headache, a condition included under secondary headaches in the International Classification of Headache Disorders, third edition (ICHD-3). We present a detailed case of a 29-year-old male who arrived at the emergency department with a bilateral, throbbing headache, agitation, and subsequent seizures. Neuroimaging revealed a left temporal arteriovenous malformation, unmasked during an acute episode of cocaine use. The patient eventually admitted to smoking crack cocaine hours before symptom onset. The clinical course included status epilepticus, psychiatric agitation, and eventual resolution of the headache after supportive management. Cocaine-induced headache may mimic primary headache disorders but carries the added risk of serious complications such as reversible cerebral vasoconstriction syndrome (RCVS), intracerebral hemorrhage, and arterial dissection. Cocaine may also exacerbate or reveal pre-existing structural abnormalities. Neuroimaging and a high index of suspicion are essential for diagnosis, particularly when patients initially deny substance use. Cocaine-induced headache is a rare but significant cause of secondary headaches. Prompt recognition and multidisciplinary management are critical due to its association with potentially life-threatening complications. Future research should focus on clarifying the pathophysiology, improving diagnostic protocols, and integrating addiction care into headache management services.