Ophthalmoplegic Migraine Symptoms, Causes And Treatment

What Is Ophthalmoplegic Migraine?

Ophthalmoplegic migraine is a rare type of migraine that involves temporary paralysis or weakness of the muscles responsible for eye movement. This condition is characterized by severe headaches accompanied by eye-related symptoms. Recently, the International Headache Society has renamed ophthalmoplegic migraine to recurrent ophthalmoplegic neuropathy (RPON).

In this article, we delve into ophthalmoplegic migraine, exploring its symptoms, potential causes, diagnostic considerations, and available treatment options.

Symptoms of Ophthalmoplegic Migraine

Common ophthalmoplegic headache symptoms include:

• Severe headache pain around the eye area
• drooping eyelids (ptosis)
• double vision (diplopia)
• weakness in the eye muscles.

These symptoms may differ from other symptoms of migraine, hence it’s important to visit a healthcare provider to properly diagnose the condition. For example, the symptoms of ophthalmoplegic migraine is more severe than retinal migraine symptoms.

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How Long Does Ophthalmoplegic Migraine Last?

Ophthalmoplegic migraine symptoms may last for days to weeks after the ophthalmoplegic headache resolves.

What Causes Ophthalmoplegic Migraine?

The exact causes of ophthalmoplegic migraine are not fully understood, but ophthalmoplegic migraine is believed to be caused by inflammation or compression of the oculomotor nerve. This nerve controls the movement of the eye muscles. The inflammation or compression can result in temporary paralysis or weakness of the affected eye muscles, leading to the characteristic eye-related symptoms.

Experts have claimed that there is a high incidence of personal or family history of migraine headaches in patients with ophthalmoplegic migraine. This suggests that migraine may be a predisposing factor in the development of the condition. In Nigerian populations, an association between ophthalmoplegic migraine and abnormal hemoglobin has been observed.

Scientists have hypothesized that ophthalmoplegic migraine could potentially be a recurring condition involving demyelination of the nerves or inflammation.They observed that the magnetic resonance imaging (MRI) findings of reversible enhancement of the third nerve could also be present in other inflammatory conditions following viral infections, such as Miller Fisher syndrome, as well as in infectious causes like HIV.[16][17] Additionally, while certain neoplastic, inflammatory, or infiltrative conditions can lead to enhancement of the cisternal part of the third nerve, the reversibility of enhancement seen in OM/RPON was not commonly observed in most of these pathological conditions.

Scientists have also proposed that proposed that ophthalmoplegic migraine may have a similar inflammatory pathophysiology to Tolosa-Hunt Syndrome (THS).

Who Experiences Ophthalmoplegic Migraine?

The demographic characteristics of ophthalmoplegic migraine contrast with those of migraine. Unlike migraine, which predominantly affects women and reaches its highest prevalence in middle-aged adults, OM/RPON is primarily observed in the pediatric population, specifically children under the age of 10. Furthermore, OM/RPON has a higher incidence among males compared to females. Nevertheless, you can still see symptoms of ophthalmoplegic migraine in adults.

Differences Between Ophthalmoplegic Migraine And Retinal Migraine

The differences between ophthalmoplegic migraine VS retinal migraine lies in their primary migraine symptoms. The primary symptom of ophthalmoplegic migraine is a debilitating headache, often localized around the eye, which can be accompanied by eye-related symptoms such as drooping eyelids (ptosis), double vision (diplopia), or weakness in the eye muscles. However, retinal migraine symptoms involves temporary migraine visual disturbances or changes without the presence of a headache. Also, the symptoms of retinal migraine primarily affect the vision in only one eye.

Other differences between ophthalmoplegic migraine VS retinal migraine lies in the cause. Ophthalmoplegic migraine is believed to be caused by inflammation or compression of the oculomotor nerve while retinal migraine is believed to be caused by changes in blood flow or electrical activity in the visual pathways of the brain.

Differences Between Ophthalmoplegic Migraine And Migraine Aura

The differences between ophthalmoplegic migraine VS migraine aura also lies in their primary symptoms. Migraine aura is reversible neurological symptom and often comes before a migraine headache. Migraine aura symptoms involves visual disturbances such as flickering lights, zigzag lines, blind spots, shimmering or pulsating lights, or temporary loss of vision. However, aura can also involve other sensory disturbances like tingling sensations, numbness, or speech difficulties (aphasic aura).

The cause of ophthalmoplegic migraine and migraine aura is also different. Migraine aura is believed to be caused by a wave of abnormal neuronal activity, known as cortical spreading depression. This triggers the visual and sensory disturbances associated with aura.

Diagnosing Ophthalmoplegic Migraine

Diagnosing ophthalmoplegic migraine involves a thorough evaluation by a healthcare professional, typically a neurologist or headache specialist. The diagnostic process may include a detailed medical history assessment, a comprehensive neurological examination, and imaging studies, such as magnetic resonance imaging (MRI) or computed tomography (CT) scans, to rule out other potential causes of the symptoms.

How Do You Treat Ophthalmoplegic Migraine?

The management of ophthalmoplegic migraine focuses on alleviating symptoms and preventing future episodes. During acute episodes, rest in a quiet, dark room and over-the-counter pain relievers may provide relief. In some cases, medications such as corticosteroids or nerve blocks may be prescribed to reduce inflammation and relieve symptoms. Preventive measures may involve identifying and avoiding triggers, adopting a healthy lifestyle, managing stress, and taking prescribed medications as recommended.

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