Transient glabellar and diffuse facial erythema during migraine attacks: A rare autonomic manifestation

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Abstract
Migraine is a primary headache disorder frequently accompanied by cranial autonomic symptoms, and recent reports have described cutaneous phenomena such as the “red forehead dot” and glabellar erythema, suggesting a link with localized autonomic dysfunction. We present two male patients with migraine who developed transient glabellar erythema during attacks. In the first case, unilateral erythema appeared during the peak of the migraine attack and resolved within 12–24 hours, whereas in the second case, symmetrical diffuse erythema involving both sides of the glabella were observed prior to headache onset and gradually regressed as the attack subsided. In both patients, neurological examination, laboratory tests, and cranial imaging were normal during the interictal period. These findings suggest that glabellar erythema may represent a rare manifestation of migraine-related autonomic dysfunction with variable distribution patterns. Recognition of this phenomenon may help prevent misdiagnosis and unnecessary diagnostic procedures.