Article

Ophthalmoplegic "Migraine" or Recurrent Ophthalmoplegic Cranial Neuropathy: New Cases and a Systematic Review

Division of Child Neurology, Department of Neurology, University of California, San Francisco, CA, USA.
Journal of child neurology (Impact Factor: 1.67). 01/2012; 27(6):759-66. DOI: 10.1177/0883073811426502
Source: PubMed

ABSTRACT Ophthalmoplegic migraine is a poorly understood neurologic syndrome characterized by recurrent bouts of head pain and ophthalmoplegia. By reviewing cases presenting to our centers in whom the phenotype has been carefully dissected, and systematically reviewing all published cases of ophthalmoplegic migraine in the magnetic resonance imaging (MRI) era, this review sets out to clearly define the syndrome and discuss possible etiologies. We found that in up to one-third of patients, the headache was not migrainous or associated with migrainous symptoms. In three-quarters of the cases involving the third nerve, there was focal nerve thickening and contrast enhancement on MRI. Observational data suggest systemic corticosteroids may be beneficial acutely. The etiology remains unclear, but may involve recurrent bouts of demyelination of the oculomotor nerve. "Ophthalmoplegic migraine" is a misnomer in that it is probably not a variant of migraine but rather a recurrent cranial neuralgia. A more appropriate name might be "ophthalmoplegic cranial neuropathy."

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    • "A diagnosis of OM seems more reasonable as the head pain prior to the ophthalmoplegia had couple of features similar to migraine, such as past history of recurrent migraine attacks, accompaniments of nausea, vomiting, and phonophobia, response to flunarizine and sodium valproate. The term of OM has been replaced by RPON in the ICHD-3 based on the fact that the interval between head pain onset and ophthalmoplegia can extend up to 14 days and focal third cranial nerve enhancement and thickening is frequently demonstrated using MRI; the headache associated with ophthalmoplegia is not always the migraine type and it is not associated with migraine symptoms such as nausea or vomiting; treatment with corticosteroids is beneficial in some patients [14,15]. But, in our patient, the ophthalmoplegia occurred immediately after the migraine-like headache and recovered within 10 days without corticosteroid treatment, and the brain MRI was normal. "
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    ABSTRACT: Recurrent painful ophthalmoplegic neuropathy (RPON), formerly named ophthalmoplegic migraine (OM), is a rare condition characterized by the association of unilateral headaches and the ipsilateral oculomotor nerve palsy. The third cranial nerve is most commonly involved in the recurrent attacks. But it is still debated whether a migraine or an oculomotor neuropathy may be the primary cause of.this disorder. Here, we report an elder patient who had a recurrent ophthalmoplegia starting with an unilateral headache circumscribed in an area shaped in a line linking the posterior-parietal region and the ipsilateral eye. And the headache had couple of features similar to that of migraine, such as past history of recurrent migraine attacks, accompaniments of nausea, vomiting, and phonophobia, response to flunarizine and sodium valproate. We may herein report a subtype of OM but not a RPON. This case report indicates that OM may exist as an entity and some OM may be wrongly grouped under the category of RPON in the current international headache classification.
    The Journal of Headache and Pain 04/2014; 15(1):19. DOI:10.1186/1129-2377-15-19 · 3.28 Impact Factor
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    ABSTRACT: Background Ophthalmoplegic migraine (OM) is a rare condition characterized by the association of headaches and an oculomotor nerve palsy. The third cranial nerve is commonly involved in recurrent attacks, whereas involvement of the sixth and fourth nerves is uncommon. It is still debated whether an uncontrolled migraine or an oculomotor neuropathy may be the primary cause of ophthalmoplegic migraine. Cases We report two patients affected by OM with normal magnetic resonance imaging findings and a history of uncontrolled migraine before an attack of OM. Conclusion The cases reported allow us to hypothesize that OM may be considered a form of migraine rather than a cranial neuralgia. It is possible that different factors such as inflammatory or structural factors, may represent a vulnerability of the nerve during a severe migraine attack causing ophthalmoplegia.
    Cephalalgia 12/2012; 32(16):1208-1215. DOI:10.1177/0333102412463493 · 4.12 Impact Factor
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    ABSTRACT: We report a 25-year-old man with a history of uncontrolled migrainous headaches who developed third nerve palsy and sensory loss over V1 distribution of trigeminal nerve, during an attack of severe migraine. Gadolinium-enhanced MRI of the brain and cavernous sinus was normal and did not disclose nerve enhancement. CT angiogram was also normal. The patient recovered uneventfully in 2 weeks on oral steroids. The commonest cranial nerve implicated in ophthalmoplegic migraine is the occulomotor nerve. Involvement of the fifth nerve has never been reported.
    Case Reports 05/2013; 2013(may27_1). DOI:10.1136/bcr-2013-009630
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