Ophthalmoplegic migraine: inflammatory neuropathy with secondary migraine?
BACKGROUND
This critical review provides a summary of the clinical presentation, neuroimaging, treatment and prognosis in pediatric ophthalmoplegic migraine (OM). The features of OM are not in keeping with its classification as a migraine-variant.


METHODS
We review 3 new and 37 reported pediatric OM cases.


RESULTS
Headache was an inconsistent feature, with 25% patients showing no evidence of pain at the initial OM episode. Patients demonstrated: 1) prolonged time for symptom resolution to occur (median time 3 weeks); 2) tendency for recurrent episodes to have more severe and persistent nerve involvement; 3) evidence of permanent neurological sequelae with recurrent episodes (30% of patients); 4) rapid improvement and shortened duration with corticosteroid therapy and; 5) transient, reversible MRI contrast enhancement of the affected cranial nerve (86% of patients). These features would not be expected in primary migraine headache.


CONCLUSIONS
A detailed understanding of the natural history of OM is essential for the clinical. This review provides support that OM may result from cranial nerve inflammation with headache a secondary and later feature of this condition.
McMillan
H J
HJ
Department of Pediatrics, Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Keene
D L
DL
Jacob
P
P
Humphreys
P
P
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D017668:Age of Onset; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008881:Migraine Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D009443:Neuritis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D009802:Oculomotor Nerve / Q000473:pathology / Q000503:physiopathology; D015840:Oculomotor Nerve Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D009886:Ophthalmoplegia / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012008:Recurrence; D013997:Time Factors