Migraine headaches triggered by palpation of chronic facial folliculitis: a peripheral and central interaction in migraine

Objective To report a case of severe migraine without aura (MwoA) headaches triggered by palpation of the folliculitis around a unilateral nosewing and the folliculitis was chronic before effective treatment for migraine, and to discuss its underlying mechanisms. Background Multiple studies have shown that peripheral mechanisms may be involved in migraine generation and there are few case reports supporting this speculation. But a clinical case demonstrating a reciprocal action between migraine headache and peripheral pathology has never been reported. Methods A case of new onset migraine headache triggered by palpation of the regional facial folliculitis which was chronic but responsive to an effective treatment for migraine was reported. We briefly reviewed the peripheral mechanisms of migraine and the reciprocal action between migraine headache and peripheral pathology. Results A 45-year-old man with chronic folliculitis around the left nosewing of which palpation, each time, would trigger an episode of headache fulfilling the criteria for MwoA by the International Classification of Headache Disorders 3rd edition (ICHD-3). And the episode of headache would be solely triggered by palpating the facial folliculitis. His chronic folliculitis around the left nosewing did not relieve after treatment with only antibiotics but resolved in the setting of no triggered migraine headache after treatment with sodium valproate. Conclusions In the setting of chronic facial folliculitis, palpating regional area can trigger migraine headache, and in particular, resolution of the chronic facial folliculitis was associated with effective therapy for migraine. This indicates that there is a peripheral and central interaction associated with neurogenic immunomodulation in migraine.