The typical manifestation of repeated migraine headache followed by ophthalmoplegia can be diagnosed as a ophthalmoplegic migraine. The diagnosis requires exclusion of other causes. MRI was useful in excluding other causes of ophthalmoplegia with headache and there is few abnormal findings on MRI in ophthalmoplegic migraine patients. A 55-year-old man with a familial and personal history of migraine was admitted due to left ptosis and diplopia followed by insidiously developed headache. The migraine headache and ophthalmoplegia were improved spontaneously within 3 days and within 4 weeks, respectively. MRI demonstrated gadolinium enhancement on the cisternal portion of left oculomotor nerve.
Diagnosis ; Diplopia ; Gadolinium* ; Headache ; Humans ; Magnetic Resonance Imaging* ; Middle Aged ; Migraine Disorders ; Oculomotor Nerve* ; Ophthalmoplegia ; Ophthalmoplegic Migraine*

Ophthalmoplegic migraine (OM) is a poorly understood neurological syndrome characterized by recurrent headaches with paresis of the ocular cranial nerves. The third cranial nerve is most commonly affected; the fourth and sixth nerve less so. The etiology, pathophysiology, and definitive treatment of OM remain unclear. We here report a 12-year-old girl who presented with recurrent OM attacks. This adolescent patient demonstrated contrast-enhanced oculomotor nerves on magnetic resonance imaging during OM episodes and marked responses to steroid treatment. The findings in our present study emphasize the difficulty of OM diagnosis, even with new International Headache Society criteria, because patients rarely fulfill all of the relevant characteristics at the same time.
Adolescent* ; Child ; Cranial Nerves ; Diagnosis ; Female ; Headache ; Humans ; Magnetic Resonance Imaging ; Migraine Disorders ; Oculomotor Nerve ; Ophthalmoplegic Migraine* ; Paresis

Ophthalmoplegic migraine is defined as recurrent unilateral headaches associated with extraocular muscle palsies. This disorder is more common in older children, but it may begin in infancy. Neuroimaging study should be performed to rule out conditions resulting in third nerve compression, such as intracranial aneurysm or mass lesions. Early treatment with corticosteroids could shorten the duration of the ophthalmoplegia and relieve the pain. We report a 8 year old boy who had severe headache with recurrent ipsilateral ophthalmoplegia that developed at the age of 2. The pediatrician should be aware that ophthalmoplegic migraine may occur in infancy and that early systemic steroid therapy is critical to prevent permanent sequelae.
Adrenal Cortex Hormones ; Child ; Headache ; Humans ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Male ; Neuroimaging ; Ophthalmoplegia ; Ophthalmoplegic Migraine* ; Paralysis

PURPOSE: To report three cases of ophthalmoplegic migraine which is a rare condition characterized by the association of headaches with an oculomotor nerve palsy. CASE SUMMARY: A 44-year-old male and two eight-year-old females were presented with diplopia developed after headaches. All of the three patients showed abnormal eye movement and they had past episodes of transient diplopia with headaches. Visual evoked potential (VEP), cerebrospinal fluid (CSF) examination, laboratory findings, and other neurologic tests were all normal, also there was no tumor or cerebrovascular disease on brain MRA & MRI. The symptoms of all patients improved gradually within several weeks from first the visit, with complete recovery seen in all three. CONCLUSIONS: Any patient who has a headache with paresis of the extraocular muscle should be considered for ophthalmoplegic migraine. To diagnose ophthalmoplegic migraine, family history, past medical history, associated symptoms and signs, neurologic examinations and neuroimaging tests are needed.
Adult ; Brain ; Diplopia ; Evoked Potentials, Visual ; Eye Movements ; Female ; Headache ; Humans ; Male ; Migraine Disorders ; Muscles ; Neuroimaging ; Neurologic Manifestations ; Oculomotor Nerve ; Ophthalmoplegic Migraine ; Paresis

Ophthalmoplegic migraine is a syndrome characterized by the typical history of migrainous headache followed by ophthalmoplegia in the absence of demonstrable intracranial lesion. Until now, investigations of regional cerebral blood flow (CBF) in patient,; with migraine have been performed during prodromal and/or headache phases by brain SPECT with Tc-99m HMPAO. However, no such paper has described patients with ophthalmoplegic migraine. We present a 14-year-old girl with 4 episodes of paroxysmal migrainous headache on the right fronto-orbital area without aura followed by ptosis and diplopia, which were always gradually resolved without aberrant regeneration over 2 or 3 weeks period. Neurologic examination showed the right internal and external ophthalmoplegia. Diagnostic studies (including laboratory testis, Tensilon test, brain MRI, and cerebral angiography) were normal. Serial brain SPECT studies with Tc-99m HMPAO showed the presence of reversible ischemia in the branches of the posterior cerebral artery.
Adolescent ; Brain* ; Diplopia ; Edrophonium ; Epilepsy ; Female ; Headache ; Humans ; Ischemia* ; Magnetic Resonance Imaging ; Migraine Disorders ; Neurologic Examination ; Ophthalmoplegia ; Ophthalmoplegic Migraine* ; Posterior Cerebral Artery ; Regeneration ; Technetium Tc 99m Exametazime ; Testis ; Tomography, Emission-Computed, Single-Photon*

The painful ophthalmoplegia may be caused by various diseases such as tuberculous meningitis, brain tumor, diabetes mellitus, aneurysm of internal carotid artery, nasopharyngeal tumor, temporal arteritis, Tolosa-Hunt syndrome, exophthalmic ophthalmoplegia, ophthalmoplegic migraine and pseudotumor of orbit. Ophthalmoplegic migraine can be diagnosed by the symptom of typical migraine followed by ophthalmoplegia but sbould be a diagnosls of exclusion. The present report describes a case of ophthalmoplegic migraine, a 9 year-old girl with migrainous headache followed by right orbital pain and oculomotor nerve palsy The patient responded well to propranolol. Literatures are briefly reviewed.
Aneurysm ; Brain Neoplasms ; Carotid Artery, Internal ; Child ; Diabetes Mellitus ; Female ; Giant Cell Arteritis ; Headache ; Humans ; Migraine Disorders ; Oculomotor Nerve Diseases ; Ophthalmoplegia ; Ophthalmoplegic Migraine* ; Orbit ; Propranolol ; Tolosa-Hunt Syndrome ; Tuberculosis, Meningeal