Trigeminal autonomic cephalgia with periorbital ecchymosis, ocular hemorrhage, hypertension and behavioral alterations

We describe a 38-year-old male in whom severe unilateral headache was assoc iated with marked palpebral edema, periorbital ecchymosis, lacrimation, con junctival injection, nasal congestion and rhinorrhea. A second, less severe headache form developed subsequently. The patient often presented severe l abile hypertension and behavioral disturbances during the crises, and there was an episode of intra-ocular hemorrhage. General, neurological and ophth almological examinations revealed nothing remarkable. We discuss possible p athogenetic mechanisms and the nosology of this case within the trigeminal autonomic cephalgias. (C) 2000 International Association for the Study of P ain. Published by Elsevier Science B.V. All rights reserved.