Ophthalmoplegia with migraine in adults: is it ophthalmoplegic migraine?
OBJECTIVE
Ophthalmoplegic migraine (OM) is a rare disorder characterized by recurrent oculomotor nerve palsy in children, following migraine headaches. We report 62 adults, seen consecutively, who developed acute ophthalmoplegia with severe attacks of migraine over a 10-year (1996-2005) period. An overwhelming majority of these patients had an antecedent worsening in severity of migraine headaches, before the ophthalmoplegic attack.


METHODS
Sixty-two patients, aged 15-68 years, with an acute attack of OM underwent detailed clinical, biochemical, and neuroradiological evaluation.


RESULTS
There were 62 patients with 86 attacks of OM. Whereas 48 patients 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%) patients, respectively. One patient had simultaneous involvement of 3rd and 6th nerves. Fifty-one (82.3%) patients exhibited an antecedent worsening in severity of migraine, before developing ophthalmoplegia during (59/95.2%) or within 24 hours (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 (P < .05).


CONCLUSIONS
We conclude: (1) OM in adults is characterized by single attacks of ophthalmoplegia in a great majority of patients; and (2) 6th nerve involvement occurs commonly. Our results indicate that 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 patients.
Lal
Vivek
V
Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Sahota
Preeti
P
Singh
Paramjeet
P
Gupta
Amod
A
Prabhakar
Sudesh
S
D000010:Abducens Nerve / Q000503:physiopathology; D020434:Abducens Nerve Diseases / Q000453:epidemiology / Q000503:physiopathology; D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D015897:Comorbidity; D003389:Cranial Nerve Diseases / Q000453:epidemiology* / Q000503:physiopathology*; D005260:Female; D006257:Head / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology* / Q000503:physiopathology*; D009802:Oculomotor Nerve / Q000503:physiopathology; D009886:Ophthalmoplegia / Q000453:epidemiology* / Q000503:physiopathology*; D013256:Steroids / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014321:Trochlear Nerve / Q000503:physiopathology; D055815:Young Adult
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D013256:Steroids