Ophthalmoplegic migraine syndrome

General: Symptoms produced by ipsilateral herniation of hippocampal gyrus of 515b13f temporal lobe through incisura tentorii; dependent upon unilateral cerebral edema due to vascular or vasomotor phenomena, intracranial aneurysm, or tumor; incidence may be greater in women with the initial attack in the first decade of life; pathogenesis is unclear, but it is likely secondary to ischemia of the ocular motor nerve.

Ocular: Severe unilateral supraorbital pain; ptosis; transitory partial or complete homolateral oculomotor paralysis; fourth or sixth nerve occasionally involved; retinal hemorrhages; papilledema (may be bilateral); moderate to severe headache with partial to complete cranial nerve III paresis including the pupil; more than one ocular nerve may be affected.

Clinical: Migraine headache, not present in all instances; dizziness; diminution in sense of smell; hypalgesia contralateral side of face; nausea/vomiting may be present; recurrent sinus arrest.

Bazak I, et al. Ophthalmoplegic migraine and recurrent sinus arrest. J Neurol Neurosurg Psychiatry 1991; 54:935.

Ehlers H. On pathogenesis of ophthalmoplegic migraine. Acta Psychiatr Neurol (Scand) 1928; 3:219.

Geeraets WJ. Ocular Syndromes, 3rd ed. Philadelphia: Lea & Febiger, 1976.

Raskin NH. Migraine and other headaches. In: Rowland LP, ed. Merritts Textbook of Neurology, 9th ed. Baltimore: Williams & Wilkins, 1995:837-845.

Stommel EW; et al. Ophthalmoplegic migraine or Tolosa-Hunt syndrome? Headache 1994; 34:177.

Van Pelt W, Andermann F. On the early onset of ophthalmologic migraine. Am J Dis Child 1964; 107:628.

Vijayan N. Ophthalmoplegic migraine: ischemic or compressive neuropathy? Headache 1980; 20:300-304.