1. A patient with red dot on the forehead A 32-year old woman presented with red dot on her forehead and eyelid ecchymosis Teaching NeuroImages Neurology Resident & Fellow Section © 2015 American Academy of Neurology

2. Vignette A-32-year-old woman with complaint of episodic headaches presented with one and half month of continuous left frontotemporal headache, pain and dragging sensation in left eye. Red forehead dot was noted along with eyelid ecchymosis. Family history of migraine was reported in patient’s father and grandmother. Neurological examination, MRI brain, MRA and MRV of brain were normal and work-up revealed no evidence for vasculitis. © 2015 American Academy of Neurology Sethi PK et al.

3. Imaging © 2015 American Academy of Neurology Sethi PK et al.

4. Imaging © 2015 American Academy of Neurology Sethi PK et al.

5. Red forehead dot syndrome and migraine revisited Likely cause of red forehead dot in the patient reported is migraine. Autonomic nervous system dysfunction has been reported in migraine and orthostatic hypotension has been reported to be more common in migraineurs. Activation of the trigeminovascular system leading to release of vasoactive peptides such as nitric oxide and substance P is the likely cause of the red forehead dot, eyelid ecchymosis as well as red ear syndrome (RES) in some migraine patients. © 2015 American Academy of Neurology Sethi PK et al.