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Ophthalmoplegia with migraine in adults: is it ophthalmoplegic migraine?
Headache: The Journal of Head and Face Pain, 04/13/09

Lal V et al. - In a trial to report on 62 adults, seen consecutively, who developed acute ophthalmoplegia with severe attacks of migraine over a 10-yr period, it was shown that ophthalmoplegic migraine (OM) in adults is characterized by single attacks of ophthalmoplegia in a majority of pts; and 6th nerve involvement occurs commonly. Moving OM to the chapter on cranial neuralgias in the second edition of the International Headache Classification may be premature, since nerve palsy occurred during a severe migraine attack in all pts.

• 62 pts, aged 15-68 yrs, with an acute attack of OM underwent detailed clinical, biochemical, and neuroradiological evaluation.

• There were 62 pts with 86 attacks of OM.
• Whereas 48 pts had a single attack, 14 had 2 or more attacks, fulfilling the International Headache Society criteria for probable and definite OM, respectively.
• At presentation, isolated abducens, oculomotor, and trochlear nerve involvements were seen in 35 (56.5%), 21 (33.9%), and 5 (8.1%) pts, respectively.
• 1 pt had simultaneous involvement of 3rd and 6th nerves.
• 51 (82.3%) pts exhibited an antecedent worsening in severity of migraine, before developing ophthalmoplegia during (59/95.2%) or within 24 hrs (3/4.8%) of a severe migraine attack, respectively.
• Detailed biochemistry and cranial neuroimaging were normal; no case had any nerve enhancement.
• Use of steroids hastened recovery.

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