Recurrent paroxysmal headache associated with facial ecchymosis

The case of a 58-year-old man with chronic paroxysmal headache and facial ecchymosis is described. The headache was pulsating, of short duration, without nausea or vomiting, and occasionally associated with flashing lights. Ecchymoses were mainly located in the middle forehead region and their appearance was associated with a reduction in intensity of the headache. Blood coagulation tests were within normal limits, and a skin biopsy of the ecchymotic lesion ruled out an underlying vasculitis. These attacks were difficult to include in any particular type of headache, although some aspects were similar to migraine headache. The possible mechanism of hemorrhages is discussed.