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NEUROIMAGE
Year : 2022  |  Volume : 70  |  Issue : 4  |  Page : 1759

Ophthalmoplegic Migraine: A Misnomer of Recurrent Painful Ophthalmoplegic Neuropathy


Departments of Neurology, Dongsan Medical Center, Keimyung University, School of Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea

Date of Submission20-Jul-2019
Date of Decision04-Nov-2019
Date of Acceptance25-Jul-2021
Date of Web Publication30-Aug-2022

Correspondence Address:
Mi-Yeon Eun
Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Buk-gu, Daegu 41404
Republic of Korea
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.355148

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How to cite this article:
Seok HY, Eun MY. Ophthalmoplegic Migraine: A Misnomer of Recurrent Painful Ophthalmoplegic Neuropathy. Neurol India 2022;70:1759

How to cite this URL:
Seok HY, Eun MY. Ophthalmoplegic Migraine: A Misnomer of Recurrent Painful Ophthalmoplegic Neuropathy. Neurol India [serial online] 2022 [cited 2022 Oct 7];70:1759. Available from: https://www.neurologyindia.com/text.asp?2022/70/4/1759/355148




A 48-year-old woman presented with migraine-like headache and diplopia. The headache was severe, throbbing, and localized in the left temporal area, and it was associated with nausea and photophobia. Her headache disappeared within a day. She had a history of migraine without aura for at least 7 years, occurring about once every 2 months. The headache during the current episode was similar to her habitual headache. The diplopia began several hours after the onset of headache and completely recovered after 6 days. She reported having had a similar episode of diplopia with migraine-like headache 7 years ago. Brain magnetic resonance imaging (MRI) showed thickening and enhancement of the cisternal portion of the left oculomotor nerve [Figure 1]. There were no abnormalities in other structures, including the orbital, parasellar, and posterior fossa region. Cerebrospinal fluid (CSF) analysis revealed a white blood cell count of 0 cells/mL, a slightly elevated CSF protein level of 62.3 mg/dL (normal range: <45 mg/dL), and a normal CSF/serum glucose ratio, suggesting inflammatory reaction. We diagnosed her with ophthalmoplegic migraine presenting with oculomotor nerve paresis. As there was evidence showing an inflammatory reaction in the oculomotor nerve, she was given high-dose intravenous steroid treatment for 5 days. During a 2-year follow-up, she had no recurrence.
Figure 1: MRI showing thickening (a, fluid-attenuated inversion recovery image) and gadolinium enhancement (b, T1-weighted gadolinium-enhanced image) of the cisternal portion of the left oculomotor nerve

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In the third edition of the International Classification of Headache Disorders (ICHD-3), ophthalmoplegic migraine has been renamed recurrent painful ophthalmoplegic neuropathy because of its response to steroids and the appearance of gadolinium enhancement or nerve thickening on MRI.[1] However, there is still debate as to whether ophthalmoplegic migraine is a migraine phenomenon or a different sort of condition entirely.[2],[3],[4] In our case, the patient showed increased CSF protein during the episode. This finding provides further support for the ICHD-3 that ophthalmoplegic migraine is a misnomer because it is not a migraine variant but rather a recurrent inflammatory cranial neuropathy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018;38:1-211.  Back to cited text no. 1
    
2.
van der Dussen DH, Bloem BR, Liauw L, Ferrari MD. Ophthalmoplegic migraine: Migrainous or inflammatory? Cephalalgia 2004;24:312-5.  Back to cited text no. 2
    
3.
McMillan HJ, Keene DL, Jacob P, Humphreys P. Ophthalmoplegic migraine: Inflammatory neuropathy with secondary migraine? Can J Neurol Sci 2007;34:349-55.  Back to cited text no. 3
    
4.
Romano LM, Besocke AG. Teaching video neuroimages: Recurrent oculomotor neuropathy with isolated ptosis vs ophthalmoplegic migraine. Neurology 2009;72:e44.  Back to cited text no. 4
    


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