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Ophthalmoplegic Migraine


Presentation

  • In both cases, enhancement and thickening of the cisternal segment of the oculomotor nerve were present at initial presentation. Ophthalmoplegia resolved spontaneously in 1 child and after steroid treatment in the other.[ncbi.nlm.nih.gov]
  • Ophthalmoplegic migraine, headache associated with oculomotor nerve dysfunction, may present early in the pediatric age group. Two cases of ophthalmoplegic migraine in infants 5 and 7-months-old are presented and their clinical management discussed.[ncbi.nlm.nih.gov]
  • The presentation, history, and ophthalmologic examination are reported as well as disease course and follow-up complications.[ncbi.nlm.nih.gov]
  • We describe a child who presented with ophthalmoplegic migraine and was demonstrated to have a deficiency of the near triad documented by eye movement and pupillary recordings.[ncbi.nlm.nih.gov]
  • RESULTS: Enhancement of the cisternal segment of the oculomotor nerve was seen in all patients at initial presentation.[ncbi.nlm.nih.gov]
Vomiting
  • And the headache had couple of features similar to that of migraine, such as past history of recurrent migraine attacks, accompaniments of nausea, vomiting, and phonophobia, response to flunarizine and sodium valproate.[ncbi.nlm.nih.gov]
  • G43.A0 Cyclical vomiting, not intractable G43.A1 Cyclical vomiting, intractable G43.B Ophthalmoplegic migraine G43.B1 Ophthalmoplegic migraine, intractable G43.C Periodic headache syndromes in child or adult G43.C0 Periodic headache syndromes in child[healthprovidersdata.com]
  • G43.A0 Cyclical vomiting, not intractable Inclusion term(s): Cyclical vomiting, without refractory migraine G43.A1 Cyclical vomiting, intractable Inclusion term(s): Cyclical vomiting, with refractory migraine G43.B Ophthalmoplegic migraine G43.B0 Ophthalmoplegic[icd10coded.com]
  • One group, with Charcot, consider this clinical syndrome a common migraine complicated in some of its attacks with ophthalmoplegia; the other group, with Möbius, consider it a relapsing ophthalmoplegia accompanied with cephalalgia and vomiting, a condition[jamanetwork.com]
  • Symptoms Symptoms include: • Headache that is like a migraine • Sometimes the headache is absent • Cranial neuropathy involving the oculomotor nerves, resulting in paralysis of the eye • Decreased consciousness • Confusion • Vomiting • Seizures It can[empowher.com]
Nausea
  • And the headache had couple of features similar to that of migraine, such as past history of recurrent migraine attacks, accompaniments of nausea, vomiting, and phonophobia, response to flunarizine and sodium valproate.[ncbi.nlm.nih.gov]
  • You may also have other symptoms, such as nausea and weakness. You may be sensitive to light and sound. Who gets migraines? About 12 percent of Americans get migraines. They can affect anyone, but you are more likely to have them if you Are a woman.[icdlist.com]
  • I get my other traditional migraine symptoms; occasional nausea, a sense of unreality, spaciness, phantom scents, dizziness, sensitivity to light, a "tight" feeling beforehand and a "loose, floating" feeling after.[forums.intpcomplex.com]
  • The clinical picture of seizure headaches includes the following features: they are usually diffuse or bifrontal; they begin abruptly at any time and last for minutes or several hours; in the majority of cases they are accompanied by nausea and vomiting[books.google.com]
  • He has had classic migraine headaches with photophobia and nausea for many years. Medications: Acetaminophen, as needed, with no relief of symptoms.[webeye.ophth.uiowa.edu]
Loss of Appetite
  • Sensitivity to light, noise and odors Nausea and vomiting, stomach upset, abdominal pain Loss of appetite Feeling very warm (sweating) or cold (chills) Pale color (pallor) Feeling tired Dizziness Blurred vision Tender scalp Diarrhea (rare) Fever (rare[my.clevelandclinic.org]
  • Repeated attacks of headache Moderately or severely painful Frequent or infrequent Last a few hours to a couple of days Often only one side of the head hurts Often experience loss of appetite, nausea, and vomiting World Federation of Neurology 3[slideshare.net]
Musculoskeletal Pain
  • Botulinum toxin A and musculoskeletal pain. Ann Readapt Med Phys 2003;46:329-32. 4. Gajraj NM. Botulinum toxin a injection of the obturator internus muscle for chronic perineal pain. J Pain 2005;6:333-7. 5. Colhado OC, Boeing M, Ortega LB.[jpgmonline.com]
Angioedema
  • Cicardi M, Aberer W, Banerji A, Bas M, Bernstein JA, et al. (2014) Classification, diagnosis, and approach to treatment for angioedema: consensus report from the Hereditary Angioedema International Working Group. Allergy 69:602-616.[omicsonline.org]
Photophobia
  • He also had vomiting and photophobia. Later the intensity of headache decreased and it became dun ache. He was admitted to a service hospital where clinical exam revealed partial ptosis. exotropia, weak adduction. supra and infraduction of left eye.[docksci.com]
  • He has had classic migraine headaches with photophobia and nausea for many years. Medications: Acetaminophen, as needed, with no relief of symptoms.[webeye.ophth.uiowa.edu]
  • […] nurse Previous medical history unremarkable –ruptured ovarian cysts 1997 und 2000 –gastritis 18 years ago –history of migrene 1-2 ictus/year Present clinical presentation increasing left frontal headache initially retrobulbar acute nausea, vomiting, photophobia[ismrmforms.org]
  • Other research suggests that migraine photophobia is caused by melanopsin-containing retinal ganglion cells, which mediate light input.[mdedge.com]
  • The headache may or may not have migrainous features; accompanied by photophobia, phonophobia, or nausea/vomiting. The ophthalmoplegia can occur immediately or up to 14 days after the headache. One or multiple nerves may be affected.[morancore.utah.edu]
Diplopia
  • Both had had previous shorter episodes of diplopia following migraine-like headaches. One recovered following an injection of botulinum toxin to the medial rectus of her affected eye 11 months after the onset of diplopia.[ncbi.nlm.nih.gov]
  • A 33-year-old man complaining of headache and diplopia lasting one hour or less and occurring weekly was found to have ophthalmoplegic migraine. He was treated unsuccessfully with propranolol HCl, ergotamine tartrate, and methysergide maleate.[ncbi.nlm.nih.gov]
  • We describe the case of an 18-year-old woman with recurrent episodic headache accompanied by binocular diplopia due to left third cranial nerve palsy. The symptoms resolve in hours. A diagnosis of atypical ophthalmoplegic migraine was established.[ncbi.nlm.nih.gov]
  • A 45-year-old woman reported multiple episodes of reversible left eye pain and diplopia stretching over 12 years. Ophthalmic examinations had repeatedly disclosed a left sixth cranial nerve palsy.[ncbi.nlm.nih.gov]
  • We encountered a 48-year-old woman who had diplopia and right ptosis. The administration of prednisolone led to the immediate improvement of her oculomotor palsy, but residual mydriasis remained.[ncbi.nlm.nih.gov]
Scotoma
  • Visual migraines result from cortical spreading depression and are also commonly termed scintillating scotoma.[en.wikipedia.org]
  • Symptoms When ocular migraine appears, photopsy (visual aura), as well as scintillating scotoma. What is it? We explain that scotomas are blind spots in the field of vision.[en.triandgo.com]
  • Scintillating scotoma was consistently absent. This attack lasted for about a week and recurred every few months.[webview.isho.jp]
  • Most common premonitory symptoms are visual: Scotomas in central portion of visual field Hallucinations Fortification spectrum (paracentral scotoma which expands into a “C” shape with luminous angles at the enlarging outer border) 16. 1 Migraine originates[slideshare.net]
  • The patient may be aware of a dark spot (positive scotoma); or he/she may not be aware of the blank spot, bump into objects, or have the impression that objects disappear (negative scotoma).[biusante.parisdescartes.fr]
Scintillating Scotoma
  • Visual migraines result from cortical spreading depression and are also commonly termed scintillating scotoma.[en.wikipedia.org]
  • Symptoms When ocular migraine appears, photopsy (visual aura), as well as scintillating scotoma. What is it? We explain that scotomas are blind spots in the field of vision.[en.triandgo.com]
  • Scintillating scotoma was consistently absent. This attack lasted for about a week and recurred every few months.[webview.isho.jp]
  • Most auras are visual and are described as bright shimmering lights around objects or at the edges of the field of vision (called scintillating scotomas) or zigzag lines, castles (teichopsia), wavy images or hallucinations.[healthcommunities.com]
  • The most common aura is visual, which is commonly experienced as a central zig-zag figure traveling into the peripheral vision, transforming into an angulated shape with a scintillating edge (the “scintillating scotoma”).[aao.org]
Painful Ophthalmoplegia
  • Recurrent painful ophthalmoplegia started in infancy in two cases, childhood in two instances and adult life in one. One child had his first attacks at 3, 5 and 12 months of age, on each occasion 10 days after an injection of triple vaccine.[ncbi.nlm.nih.gov]
  • The original observ... more We present two patients with recurrent painful ophthalmoplegia starting in early childhood. Clinically, both patients fulfilled the criteria for ophthalmoplegic migraine.[scinapse.io]
  • Mucocele of the sphenoidal sinus or tumors or inflammatory lesions that invade the cavernous sinus can cause painful ophthalmoplegia.[pediatricneurosciences.com]
  • Clinicopathological correlation in a case of painful ophthalmoplegia: Tolosa-Hunt syndrome. J Neurol Neurosurg Psychiat 1989; 52:1290–3. Hannerz J. Pain characteristics of painful ophthalmoplegia (the Tolosa-Hunt syndrome).[yumpu.com]
  • Painful ophthalmoplegia: an unresolved clinical problem.[eanpages.org]
Headache
  • Abstract Ophthalmoplegic migraine (OM) is a rare form of primary headache. Because of its rarity, only a few cases, mostly symptomatic, are reported.[ncbi.nlm.nih.gov]
  • It is unlikely that OM is a variant of migraine, since the headache often lasts for a week or more and there is a latent period of up to 4 days from the onset of headache to the onset of ophthalmoplegia.[ncbi.nlm.nih.gov]
  • However, it remains a fact that most cases of OM/RPON described in the literature have a history of migraine and that the headache during OM/RPON often has migrainous features.[ncbi.nlm.nih.gov]
  • This case report indicates that OM may exist as an entity and some OM may be wrongly grouped under the category of RPON in the current international headache classification.[ncbi.nlm.nih.gov]
  • A 21-year-old man had right frontal throbbing headaches recurring twice a year. His headache lasted for 1 to 5 days and was followed by slight drooping of his eyelid and double vision that lasted for approximately 3 months.[ncbi.nlm.nih.gov]
Vertigo
  • Vertebrobasilar Migraine A vertebrobasilar or vertiginous migraine is preceded by dizziness or vertigo. It is important to note that frequent and recurrent periods of vertigo may be caused by an issue in the lower part of the brain.[migrainescenter.org]
  • Vertigo is a common complaint for many people with migraine, but frequent and recurring episodes of vertigo may be caused by a problem in the lower part of the brain.[healthline.com]
  • Symptoms include severe headache, vertigo, double vision, slurred speech and poor muscle coordination. This type occurs primarily in young people.[healthcommunities.com]
  • Benign paroxysmal vertigo of childhood Benign paroxysmal vertigo of childhood (BPVC) is characterized by brief episodes of vertigo and disequilibrium lasting for hours, without headache, aura, hearing loss, or tinnitus.[emedicine.medscape.com]
Dizziness
  • I get my other traditional migraine symptoms; occasional nausea, a sense of unreality, spaciness, phantom scents, dizziness, sensitivity to light, a "tight" feeling beforehand and a "loose, floating" feeling after.[forums.intpcomplex.com]
  • Basilar Migraine This usually causes dizziness and vertigo before the headache. However, it may also cause loss of coordination, ringing in ears or speech problems. It mimics a stroke.[migrainescenter.org]
  • Arachnoid cysts of the cranial posterior fossa may produce symptoms tpical of a tumour such as headache dizziness Results of a complete physical head and neck examination were normal.[11let.eu]
  • Basilar migraine Basilar migraine, also known as Bickerstaff syndrome, typically causes dizziness and vertigo prior to a headache.[healthline.com]
  • The onset of the headache may be associated with temporary numbness, dizziness or vision changes. Retinal migraine.[my.clevelandclinic.org]
Polyradiculoneuropathy
  • We present 3 patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) with extensive and diffuse hypertrophy of the nerve roots and peripheral nerves.[scinapse.io]

Workup

  • MRI of the brain post enhancement is a useful adjunct in the diagnosis and treatment of ophthalmoplegic migraine and should be considered as part of a workup of ophthalmoplegic migraine in children.[ncbi.nlm.nih.gov]
  • Discussion The differential diagnoses and workup of an isolated sixth nerve palsy usually depends on the age and the clinical circumstances of the patient.[dovepress.com]
  • The cerebral MRI, left temporal artery biopsy and blood workup at the time were unremarkable apart from a hypercholesterolemia.[eanpages.org]
  • Gastroenterologic evaluation and workup typically yield unremarkable results. [48] Abdominal migraine symptoms are usually relieved with sleep. Antiemetics may help in aborting an acute attack.[emedicine.medscape.com]
HLA-B27
  • All of them were HLA-B27 positive whereas one healthy sibling was HLA-B27 negative.[ncbi.nlm.nih.gov]

Treatment

  • Ophthalmoplegia resolved spontaneously in 1 child and after steroid treatment in the other. Both postresolution MRIs demonstrated decrease in enhancement and thickening of the third nerve.[ncbi.nlm.nih.gov]
  • Recently we have seen a 12-month-old girl with OM that appeared to respond to treatment with propranolol.[ncbi.nlm.nih.gov]
  • Thorough coverage for each neurological disease clearly defines age at onset, course of illness, clinical features, and treatment options. Differential diagnosis tables and treatment algorithms expedite clinical decision making.[books.google.com]
  • The boy exhibited dramatic response to steroid treatment. The clinical features of ophthalmoplegic migraine and Tolosa-Hunt syndrome overlapped in this patient.[ncbi.nlm.nih.gov]
  • Hopefully, this will help in modification of the criteria, better understanding the etiology, correct diagnosis, and determining appropriate treatment for OM.[ncbi.nlm.nih.gov]

Prognosis

  • 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.[ncbi.nlm.nih.gov]
  • Prognosis is good because symptoms almost always resolve, but, after several episodes, some deficits may persist.[ncbi.nlm.nih.gov]
  • Yet the effects were either unclear, not beneficial or even harmful in 35%, 8%, and 4% respectively.4 Prognosis: Prognosis in OM/RPON is generally excellent and most patients can experience a full recovery in days to weeks.[morancore.utah.edu]
  • The prognosis is favourable unless very frequent attacks occur. Palsies of other cranial nerves like trochlear, abducens and first division of trigeminal nerve have been described [6]. REFERENCES I. Robertson WC Jr. Schnintzler ER.[docksci.com]
  • Medicines used to treat retinal migraines include aspirin, other NSAIDS, and medicines that reduce high blood pressure. [4] Prognosis [ edit ] In general, the prognosis for retinal migraine is similar to that of migraine headache with typical aura.[en.wikipedia.org]

Etiology

  • The etiology remains unclear, but may involve recurrent bouts of demyelination of the oculomotor nerve. "Ophthalmoplegic migraine" is a misnomer in that it is probably not a variant of migraine but rather a recurrent cranial neuralgia.[ncbi.nlm.nih.gov]
  • Although migraine or neuropathy have been suggested as etiologies, the precise etiology remains unclear.[ncbi.nlm.nih.gov]
  • […] one of the diagnostic criteria in the classification of ophthalmoplegic migraine and that a trial of steroid is worthwhile in the presence of enhancement of the oculomotor nerve since ophthalmoplegic migraine may be noninfectious but inflammatory in etiology[ncbi.nlm.nih.gov]
  • This does not exclude migraine as an etiologic agent but also recognizes tumors, infections and fractures as being more common.[ncbi.nlm.nih.gov]
  • Ophthalmoplegic migraine (OM) is a childhood disorder of uncertain etiology manifesting recurrent unilateral headache associated with a transitory oculomotor (usually IIIrd nerve) palsy.[ncbi.nlm.nih.gov]

Epidemiology

  • Thus major advances in headache epidemiology may be expected to occur when migraine is defined by a laboratory finding'. ‏[books.google.com]
  • Descriptive epidemiology of epilepsy: contributions of population-based studies from Rochester, Minnesota. Mayo Clin Proc 1996; 71:576-586. PMid:8642887 Headache Classification Subcommittee of the International Headache Society.[smartscitech.com]
  • Epidemiology OM/RPON is a rare condition with a prevalence of 0.7 per million6; it usually begins in childhood.2,3 A systematic review authored by Gelfand found a median age of onset at 8 years old (interquartile range 3, 16).[morancore.utah.edu]
  • Epidemiology and genetics of cluster headache. Lancet Neurol. 2004;3(5):279-283. 24. Mitsikostas DD, Edvinsson L, Jensen RH, et al.[midolordecabeza.org]
  • .: An epidemiological survey of hemiplegic migraine. Cephalalgia 2002; 22: 361-375. 40.[psjd.icm.edu.pl]
Sex distribution
Age distribution

Pathophysiology

  • The possible pathophysiology of this unique finding is discussed.[ncbi.nlm.nih.gov]
  • Implications from this finding are discussed in relation to the pathophysiology of ophthalmoplegic migraine.[ncbi.nlm.nih.gov]
  • We speculate that this and perhaps other cases of OM may have a different pathophysiology related to compression of the IIIrd nerve by an adjacent vascular structure that could activate the trigeminovascular system and produce migrainous pain.[ncbi.nlm.nih.gov]
  • A more detailed clinical description of the headache during OM/RPON and additional results from imaging and possibly histology will be needed to better understand the pathophysiology of the disease and its relationship to typical migraine.[ncbi.nlm.nih.gov]
  • The pathophysiology may be a trigeminovascular migraine epiphenomenon that is dependent on the unique oculomotor nerve anatomy and porous blood-nerve barrier at the emergence of the oculomotor nerve from the brainstem and the sequelae of demyelination[ncbi.nlm.nih.gov]

Prevention

  • Early high-dose corticosteroid treatment is recommended to rapidly resolve an acute episode and to potentially prevent permanent abnormal oculomotor nerve signs.[ncbi.nlm.nih.gov]
  • Thus, medication for migraine prophylaxis might be needed to prevent RPON. KEYWORDS: headache; migraine; mydriasis; oculomotor palsy; ophthalmoplegic migraine; recurrent painful ophthalmoplegic neuropathy[ncbi.nlm.nih.gov]
  • Certain natural treatments, such as riboflavin (vitamin B2) and coenzyme Q10, may help prevent migraines. If your magnesium level is low, you can try taking magnesium. There is also an herb, butterbur, which some people take to prevent migraines.[icdlist.com]
  • Thus, medication for migraine prophylaxis might be needed to prevent RPON.[jstage.jst.go.jp]
  • Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. ‏[books.google.com]

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