Teaching NeuroImages: Red forehead dot syndrome and migraine revisited

A 32-year-old woman with episodic headaches presented with 1.5 months of continuous left frontotemporal headache, pain, and dragging sensation in the left eye. Red forehead dot was noted along with eyelid ecchymosis (figures 1 and 2). Family history of migraine was reported in the patient's father and grandmother. Neurologic examination and brain MRI, magnetic resonance angiography, and magnetic resonance venography had normal results and workup revealed no evidence for vasculitis. Activation of the trigeminovascular system leading to release of vasoactive peptides is the likely cause of the red forehead dot and eyelid ecchymosis seen in some migraine patients.1