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. 2019 Jun;9(3):256-262.
doi: 10.1212/CPJ.0000000000000653.

Are some ophthalmoplegias migrainous in origin?

Vivek Lal  1 , Louis Caplan  1
Affiliations

Are some ophthalmoplegias migrainous in origin?

Vivek Lal et al. Neurol Clin Pract. 2019 Jun.

Abstract

The 3rd edition of the International Classification of Headache Disorders replaced the term ophthalmoplegic migraine (OM) with Recurrent Painful Ophthalmoplegic Neuropathy (RPON) based on the presence of contrast enhancement of the involved cranial nerves on Gadolinium-enhanced magnetic resonance imaging. We review our experience and publications concerning ophthalmoplegia, migraine, and RPON. Majority of cases of acute ophthalmoplegia are associated with severe migrainous headaches. A positive history of migraine, increased severity of migraine headaches before the onset of ophthalmoplegia, and the close temporal association between migraine attacks and ophthalmoplegia all suggest an important role played by migraine in the causation of ophthalmoplegia. Enhancement of the involved cranial nerves may be due to the neuro-inflammatory cascade associated with migraine. OM should be considered along with RPON in differential diagnoses of painful ophthalmoplegic syndromes.

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Figures

Figure 1
Figure 1. Sixth cranial nerve palsy in ophthalmoplegic migraine
Sixth cranial nerve palsy in a 38 year old lady with ophthalmoplegic migraine. Note palsy of left lateral rectus (upper panel) during the attack and complete recovery (lower panel) after 10 weeks with antimigraine prophylaxis alone.
Figure 2
Figure 2. Recurrent cranial nerve palsies in ophthalmoplegic migraine
Recurrent cranial nerve palsies in ophthalmoplegic migraine. Top panel: note palsy of left lateral rectus (A) during 1st attack of ophthalmoplegic migraine. Middle panel: left partial 3rd nerve palsy (B) during 2nd attack of ophthalmoplegic migraine after 8 weeks of first attack. Bottom panel: complete resolution of 3rd cranial nerve palsy (C) after 3 weeks of treatment with prednisone.
Figure 3
Figure 3. Pathogenesis of nerve damage in ophthalmoplegic migraine
Proposed mechanism for palsies and enhancement of ocular motor nerves on magnetic resonance imaging in ophthalmoplegic migraine (adapted and modified from Lal et al.).
See this image and copyright information in PMC

Comment in

  • Spotlight on headache.
    Lipton RB. Lipton RB. Neurol Clin Pract. 2019 Jun;9(3):182. doi: 10.1212/CPJ.0000000000000679. Neurol Clin Pract. 2019. PMID: 31342958 Free PMC article. No abstract available.

References

    1. Charcot JM. Sur un cas de migraine ophthalmoplegique (paralysie oculo-motriceperiodique). Progr Med (Paris) 1890;31:83–86.
    1. Walsh JP, O'Doherty DS. A possible explanation of the mechanism of ophthalmoplegic migraine. Neurology 1960;10:1079–1084. - PubMed
    1. Walsh FB, Hoyt NF. Clinical Neuro-Ophthalmology. Baltimore, MD: Williams &Wilkins; 1969.
    1. Lal V. Ophthalmoplegic migraine: past, present and future. Neurol India 2010;58:15–19. - PubMed
    1. Verhagen WIM, Prick MJJ, AznDijk Van R. Onset of ophthalmoplegic migraine with abducens palsy at middle age? Headache 2003;43:798–800. - PubMed