Migrainous periorbital ecchymosis

Equimose periorbitária na enxaqueca

A 27-year-old woman, with migraine with aura since age 9, developed two episodes of alternating periocular ecchymosis, with one-month interval, which happened a few hours after the headache onset (Figure 1). The pain lasted more than usual (48 to 72 hours), and the ecchymosis persisted from three to four days. After over two years of follow-up, there was no recurrence of such episodes.

Figure 1.
Periorbital ecchymosis after a migraine attack.

The spontaneous periorbital hematoma/ecchymosis in migraine is a rare entity assumed to reflect complex neurovascular changes^1,2, specifically vasodilation of intracranial and extracerebral blood vessels through the release of vasoactive substances³.

References

• ¹
  Shevel E. The extracranial vascular theory of migraine - a great story confirmed by the facts. Headache. 2011 May;51(3):409-17. https://doi.org/10.1111/j.1526-4610.2011.01844.x
  » https://doi.org/https://doi.org/10.1111/j.1526-4610.2011.01844.x
• ²
  Obermann M, Yoon MS, Dommes P, Kuznetsova J, Maschke M, Weimar C, et al. Prevalence of trigeminal autonomic symptoms in migraine: a population-based study. Cephalalgia. 2007 Jun;27(6):504-9. https://doi.org/10.1111/j.1468-2982.2007.01316.x
  » https://doi.org/https://doi.org/10.1111/j.1468-2982.2007.01316.x
• ³
  Kalendovsky Z, Austin JH. Changes in blood clotting systems during migraine attacks. Headache. 1977 Jan;16(6):293-312. https://doi.org/10.1111/j.1526-4610.1976.hed1606293.x
  » https://doi.org/https://doi.org/10.1111/j.1526-4610.1976.hed1606293.x

Publication Dates

• Publication in this collection
  21 Sept 2020
• Date of issue
  Sept 2020

History

• Reviewed
  14 Mar 2020
• Received
  21 Apr 2020
• Accepted
  04 May 2020