Ophthalmoplegic Migraine

Ophthalmoplegic migraine is a rare presentation of migraine complicated by an isolated oculomotor paresis. This type of migraine headache is also connected to the weakness of the muscles around the eye. It involves the paresis of the third, fourth, and sixth cranial nerves. It is important to confirm the diagnosis of ophthalmoplegic migraine, as similar symptoms can be caused by pressure on the nerves behind the eye. Some children experience vision changes ("auras") during a headache. A sick feeling in the stomach or vomiting is common. Many children avoid bright lights, loud noises, or strong odors, as these seem to make the headache worse. An inherited tendency is believed to make some people more likely to have a migraine after some minor trigger, although no single theory explains how the human body produces all the symptoms of a typical migraine headache. A unilateral (may be alternating or bilateral in some) headache may last for hours or days, and the child may have dilation of the pupils (mydriasis), coupled with the inability to move the eye upward, downward, or medially, as well as a drooping (ptosis) of the upper eyelid. They are some cases of it affecting adults but only in a small amount of instances. Opthalmoplegic migraines cause an individual to experience severe headaches and it can affect a person's vision. The condition is not contagious.

The pain usually surrounds the eyeball and lasts from a few days to a few months, caused by weakness of the muscles surrounding the eye. Vasodilation of extracranial vessels is believed to underlie the headache, and vasoconstriction to account for the ophthalmoplegia. This is a rare variety of Migraine Headache often involving symptoms associated with the paresis of the third, fourth and sixth cranial nerves. Whether the vascular insult involves the central or peripheral portions of the oculomotor nerve is still uncertain. We describe a child who presented with ophthalmoplegic migraine and was demonstrated to have a deficiency of the near triad documented by eye movement and pupillary recordings. Although migraine headaches have long been considered a benign (relatively harmless) condition, they can cause a lot of damage to a person's quality of life and ability to take part in normal life activities. Vergence amplitudes appropriate to fixation distance were elicited for Snellen optotypes but not to a point source of light The cause is unknown, and other disorders (e.g., tumors, aneurysms, diabetes, Glaucoma , vascular anomalies, and neuromuscular disorders) must be ruled out using tests such as MRI (shows structure) or MRA (shows circulation) of the brain.  Treatment is often similar to ordinary migraine treatment using various medications (e.g., Calcium channel blockers, beta blockers, etc.)

Symptoms of Ophthalmoplegic migraine

Some common Symptoms of Ophthalmoplegic migraine :

• Nausea.
• All or parts of the third-nerve-innervated extraocular and intraocular muscles may be involved at the acute stage.
• Vomiting.
• Ophthalmoplegia develops after the headache.
• Diarrhea.
• An efferent pupil defect and accommodative weakness commonly accompanies the ophthalmoplegia.
• Enlargement and enhancement of the third nerve on MRI is usually present.
• Anxious or restlessness.
• Confusion.
• Sensitivity to light, noise and odors.

Treatment of Ophthalmoplegic migraine

• Treatments for the headache involve neurologist referral .
• No proven medications, though beta-blockers and calcium-channel blockers have been tried with some success.
• In migraine-triggered seizures, antiepileptic agents are drugs of choice because of their dual benefit in migraine prevention and seizure control .
• Work-up of pupil-involving third nerve palsy must exclude aneurysm or other structural etiology .
• Patients with vertiginous migraine rarely respond to migraine prophylactic therapy. Anecdotal data are available on the benefit of verapamil, a calcium channel blocker, and amitriptyline, a tricyclic antidepressant, because of their anticholinergic properties, which may help control the vertigo.