Atypical Chronic Headache and Recurrent Facial Ecchymosis: A Case Report.

We present the case of a 57-year-old woman with chronic paroxysmal headache and recurrent facial ecchymosis. The headaches are chronic, unilateral, sharp, electric shock-like, of short duration, without nausea nor vomiting, ptosis, miosis, conjunctival injection nor tearing. The facial ecchymoses have been mainly located in the periorbital and epicanthal areas. General, neurological and ophthalmological examinations were unremarkable. Work-up was unremarkable, including negative skin biopsy. The headache was difficult to include in any particular category given the atypical features, but the characteristics were suggestive of a variant of trigeminal autonomic cephalalgia with lack of responsiveness to indomethacin. We discuss the possible pathogenetic mechanism of the occurrence of facial ecchymosis in primary headache disorders.