More evidence for headache and spontaneous glabellar ecchymosis: Does the headache type or the treatment response matter? A neurovascular hypothesis

We present a 37-year-old man with erythema-like lesions, which devel-oped after two different headache episodes that had not responded tosumatriptan treatment and gradually resolved over the next few days. Thepatient provided a signed release for this publication.Thefirst type of headache was throbbing and pulsatile, lasting for80 min about 3–4 times per month with minimal nausea and right eyetearing; the headache was located occasionally at the right eye and fore-head and was associated with multiple episodes of superior glabellarecchymosis. The patient also reported a second type of treatment-refractory headache that was moderate in severity, pulsatile, andbifrontally located and was not associated with autonomicfindings butgradually progressed to very severe pulsatile headaches that resulted insignificant glabellar ecchymosis (Fig. S1). He disclosed habitual rubbingof the forehead or face during pain episodes, making an‘artificial’post-traumatic skin ecchymosis unlikely.