An ophthalmoplegic migraine is one that begins around one eye and is followed by third or sixth nerve palsy, causing a paralysis of the eye. It is most common in children.
• Headache that is like a migraine
• Sometimes the headache is absent
• Cranial neuropathy involving the oculomotor nerves, resulting in paralysis of the eye
• Decreased consciousness
It can last a few days or can continue for a few months. Once classed as a migraine variant, doctors now believe it is closer to neuralgia in its symptomology.
Diagnosis is performed by taking a full medical history, doing a lumbar puncture (to rule out conditions like meningitis), MRI scan of the brain and a magnetic resonance angiography (MRA) which is another type of scan that provides pictures of the blood vessels. The blood vessels to the brain can then be examined to rule out aneurysms or other problems. If no other conditions are detected, the patient may be diagnosed with ophthalmophlegic migraine.
What Causes Ophthalmoplegic Migraine?
It is thought to be caused by a demyelinating of the third and sixth cranial nerves. Myelin is the protective covering on the nerves (think of plastic coating around a wire). When this becomes eroded, disease can occur.
Most children grow out of ophthalmoplegic migraines and when they occur in adults, they also resolve in most cases. If the patient has had several attacks, some deficits in the eye may remain as a consequence.
How is it Treated?
It can be treated with prednisone, a powerful corticosteroid that reduces inflammation. It is an immunosuppressant which means the person taking it will be more likely to get colds and other infections. Other options include beta blockers (drugs that block nerve transmissions) and calcium channel blockers (that block the amount of calcium that is absorbed and act as a muscle relaxant).
Most people enjoy complete recovery after a varying period of time.
Ophthalmoplegic migraine, Curr Pain Headache Rep. 2004 Aug;8(4):306-9. Abstract: http://www.ncbi.nlm.nih.gov/pubmed/15228891