Recurrent headache and facial ecchymosis: a case of dermatitis artefacta?

I read the case recently published as an image gallery in the Journal about a 22 year-old woman, who developed transient and relapsing facial ecchymosis during attacks of trigeminal cephalalgias [1]. As laboratory and imaging were unremarkable, the authors suggested that the cutaneous symptoms "may result from blood extravasation to skin due to trigemino-vascular activation and autonomic vascular dysfunction". Upon examination of the clinical photographic features, the patient displays a striking dark-red, well-delimitated, sometimes linear streak of the right cheek, extending to the neck up to the upper chest.