Skin ecchymosis in migraine patients: a retrospective and exploratory study

Migraine is a recurrent headache disorder characterized by moderate to severe, throbbing pain, typically unilateral. It can be classified as migraine with or without aura, depending on the presence or absence of visual or sensory disturbances known as auras, respectively.

The objective of this study was to determine the prevalence of ecchymosis in patients with migraine and its accuracy parameters in the differential diagnosis between migraine and tension-type headache (TTH).

Patients with migraine or tension-type headache, diagnosed according to the International Classification of Headache Disorders (ICHD-3) criteria, were assessed regarding the prevalence of skin ecchymosis, both during headache attacks and in the pain-free period.

Four hundred patients were investigated. The subjects were equally divided in two groups presenting the diagnosis of migraine and TTH. Ages were, respectively, 37.3 ± 9.0 years for migraineurs and 40.0 ± 10.0 years for sufferers of TTH. Ecchymosis was present in 76% of patients with migraine and in 11% of patients with TTH (p < 0.0001). In both patients with migraine and TTH, ecchymosis predominated in women, respectively in 92.1% and 63.6% (p < 0.0001). Among the 152 patients with migraine who reported ecchymosis, they were present in most of headache attacks (69.7%), occurred within the first 24 hours after the headache onset (68.4%) and were unilateral in location (65.1%), mainly on the arms (34.9%) and thigh (24.3%). The ecchymosis were larger than 2 cm in diameter (60.5%), lasting longer than four days (89.5%). During the presence of ecchymosis, the headache was unilateral (91.5%), pulsatile (80.3%), severe to very severe (67.8%) and worsening with physical activity (75%).

Intermittent skin ecchymosis may be a differentiating factor between migraine and tension-type headache and a specific marker of migraine to be considered as a criterion for its diagnosis.